Mid-upper arm circumference predicts death in adult patients admitted to a TB ward in the Philippines: A prospective cohort study

BackgroundThe Philippines is ranked 3rd globally for tuberculosis incidence (554/100,000 population). The tuberculosis ward at San Lazaro Hospital, Manila receives 1,800–2,000 admissions of acutely unwell patients per year with high mortality. Objectives of this prospective cohort study were to quantify the association of under-nutrition (primary) and diabetes (secondary) with inpatient mortality occurring between 3–28 days of hospital admission in patients with suspected or previously diagnosed TB.Methods and resultsWe enrolled 360 adults (≥18 years); 348 were eligible for the primary analysis (alive on day 3). Clinical, laboratory, anthropometric and enhanced tuberculosis diagnostic data were collected at admission with telephone tracing for mortality up to 6 months post-discharge. In the primary analysis population (mean age 45 years, SD = 15.0 years, 70% male), 58 (16.7%) deaths occurred between day 3–28 of admission; 70 (20.1%) between day 3 and discharge and documented total post-day 3 mortality including follow-up was 96 (27.6%). In those in whom it could be assessed, body mass index (BMI) ranged from 11.2–30.6 kg/m2 and 141/303 (46.5%) had moderate/severe undernutrition (BMI2). A sex-specific cut-off for mid-upper arm circumference predictive of BMI2 was associated with inpatient Day 3–28 mortality in males (AOR = 5.04, 95% CI: 1.50–16.86; p = 0.009; p = 0.032 for interaction by sex). The inability to stand for weight/height for BMI assessment was also associated with mortality (AOR = 5.59; 95% CI 2.25–13.89; pConclusionThis research supports the use of mid-upper arm circumference for triaging acutely unwell patients and the design and testing of nutrition-based interventions to improve patient outcomes.背景 菲律宾的结核病发病率位居全球第三位，为每10万人口554例。马尼拉圣拉萨罗医院的结核病病房每年收治1800~2000名急症重症患者，且患者死亡率居高。 研究目的 本前瞻性队列研究（prospective cohort study）旨在量化营养不良（主要研究指标）与糖尿病（次要研究指标）与疑似或既往确诊结核病患者在入院后3~28天内住院死亡率的关联。 方法与结果 本研究共纳入360名成年患者（年龄≥18岁），其中348名符合主要分析纳入标准（入院第3天仍存活）。研究人员在患者入院时收集其临床、实验室检查、人体测量学（anthropometric）及强化结核病诊断相关数据，并通过电话追踪随访患者出院后6个月内的死亡情况。 在主要分析人群中，患者平均年龄为45岁，标准差（standard deviation, SD）为15.0，其中70%为男性；该人群中，入院第3~28天内共有58例死亡，占比16.7%；第3天至出院期间共有70例死亡，占比20.1%；纳入随访数据后，第3天后的总死亡率为96例，占比27.6%。 在可评估体质量指数（body mass index, BMI）的患者中，其BMI范围为11.2~30.6 kg/m²，其中141/303（46.5%）存在中/重度营养不良（BMI2）。针对预测BMI2的上臂围（mid-upper arm circumference, MUAC）性别特异性截断值，与男性患者入院第3~28天的住院死亡率显著相关（校正优势比（adjusted odds ratio, AOR）=5.04，95%置信区间（confidence interval, CI）：1.50~16.86；p=0.009；性别交互作用p=0.032）。无法站立以完成体质量/身高测量进而计算BMI的情况同样与死亡率相关（AOR=5.59；95% CI：2.25~13.89；p）。 结论 本研究证实，上臂围可用于急症重症患者的分诊，同时可为改善患者预后的营养干预措施的设计与验证提供支持。