Association between serum albumin levels and in-hospital deaths due to tuberculosis.

SETTING: A tuberculosis (TB) referral hospital in the state of Bahia, north-eastern Brazil. OBJECTIVE: To evaluate the association between serum albumin at admission and in-hospital deaths due to TB. DESIGN: A prospective cohort study of 373 patients hospitalised with TB. Samples were systematically collected from all patients at hospital admission for measurement of serum albumin levels. In-hospital death was the study endpoint. Univariate analysis was used to evaluate the association between serum albumin at admission and mortality from TB, and multivariate logistic regression was used to adjust for potential confounding variables. RESULTS: The average age of the 373 patients was 41.1 years (+/-15.2); 77.2% (288/373) were male; 45 eventually died in hospital (in-hospital death rate 12.1%, 95%CI 9.0-15.7). Multivariate analysis showed that the presence of low serum albumin levels (< or =2.7 g/dl) was strongly and independently associated with in-hospital death due to TB (adjusted OR 3.38, 95%CI 1.51-7.59; P = 0.001), even after adjusting for potentially confounding variables identified in the univariate analysis (age, comorbidities, TB-human immunodeficiency virus [HIV] coinfection and history of previous default from treatment). CONCLUSION: Our results highlight the importance of measuring serum albumin levels at admission to hospital as an indicator of the prognosis for patients hospitalised with TB.

Chest radiograph abnormalities in patients hospitalized with leptospirosis in the city of Salvador, Bahia, Brazil.

This study was designed to estimate the prevalence of pulmonary radiograph abnormalities and describe the distribution of the patterns of radiographic alterations among patients hospitalized with leptospirosis. Chest radiographs of 139 patients hospitalized with leptospirosis in Couto Maia Hospital, in Salvador, Bahia, Brazil, between July, 1997, and July, 1999, were analyzed. The radiographs were requested soon after hospital admission, independent of the clinical manifestations of the patients. Only the first radiograph was considered. Pulmonary radiograph alterations were recorded in 35/139 patients (25.2%); 95% mid-point confidence interval = 18.5% to 32.9%. Among the patients with radiograph alterations, alveolar infiltrate was seen in 26/35 (74.3%). The lesions were bilateral in 54.3% and located in the inferior lobes in 45.5%. Pleural effusion, represented by blunting of the costo-phrenic angle, was detected in 8.6% of the patients. The pattern of the pulmonary alterations, predominantly bilateral alveolar infiltrates, is consistent with the evidence that the basic pulmonary alteration in leptospirosis is a generalized capillaritis.