Sepsis in TB? - Prevalence of and Indicators Associated with High National Early Warning Score (NEWS) in Patients with Pulmonary Tuberculosis in Zambia.
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Scopazzini M.S.
Banda I.
Calderwood C.J.
Chansa P.
Cheeba M.
Chipili C.M.
Kranzer K.
Limbada M.
Mateyo K.J.
Musukuma R.
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2025
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Background: An ambulatory model of care for tuberculosis (TB), which is advocated across high-burden, low-resource settings may overlook patients who present acutely unwell. We investigated the prevalence and determinants of severe physiological derangement indicative of possible sepsis in patients with pulmonary tuberculosis (PTB). Methods: We recruited outpatients with bacteriologically confirmed PTB at a primary healthcare facility in Lusaka, Zambia between 1st November, 2023 and 15th October, 2024. Patients underwent comprehensive clinical assessment and blood sampling for C-reactive protein (CRP). We used the National Early Warning Score (NEWS - developed in the United Kingdom), which categorises vital signs into severity scores. We used NEWS>=5 as indicative of possible sepsis and then determined the prevalence of and factors associated with NEWS>=5. Findings: We recruited 252 consecutive participants with bacteriologically-confirmed PTB (mean age 35.4 years, n=190 male, n=72 people living with HIV (PLWHIV)). Prevalence of NEWS>=5 was 43.6% (n=110) and median CRP in this group was 101 g/dl (IQR 59-148). In adjusted models, NEWS>=5 was associated with being underweight (odds ratio [OR] 2.76, 95% CI 1.65-4.68); among PLWHIV, with untreated HIV (OR 2.86, 95% CI 1.20-7.33). Odds of severe physiological derangement doubled with every lognormal increase in CRP (OR 2.01, 95% CI 1.50-2.78). Interpretation: Almost half of participants presenting to outpatient TB care in Zambia had evidence of severe physiological derangement consistent with possible sepsis. This was strongly associated with malnutrition and CRP. Simple clinical scoring tools and point-of-care CRP may play important roles in enhancing clinical care for people with TB across low-resource settings. Copyright © 2025, The Authors. All rights reserved.
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