Predictors of in-hospital mortality among patients with pulmonary tuberculosis: a protocol of systematic review and meta-analysis of observational studies

INTRODUCTION: Tuberculosis (TB) continues to be a major public health issue worldwide, with 1.4 million deaths occurring annually. There is uncertainty regarding which factors are associated with in-hospital mortality among patients with pulmonary TB. This knowledge gap complicates efforts to identify and improve the management of those individuals with TB at greatest risk of death. The aim of this systematic review and meta-analysis is to establish predictors of in-hospital mortality among patients with pulmonary TB to enhance the evidence base for public policy. METHODS AND ANALYSIS: Studies will be identified by a MEDLINE, EMBASE and Global Health search. Eligible studies will be cohort and case-control studies that report predictors or risk factors for in-hospital mortality among patients with pulmonary TB and an adjusted analysis to explore factors associated with in-hospital mortality. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to summarise the findings of some reported predictors. Teams of 2 reviewers will screen the titles and abstracts of all citations identified in our search, independently and in duplicate, extract data, and assess scientific quality using standardised forms quality assessment and tools tailored. We will pool all factors that were assessed for an association with mortality that were reported by >1 study, and presented the OR and the associated 95% CI. When studies provided the measure of association as a relative risk (RR), we will convert the RR to OR using the formula provided by Wang. For binary data, we will calculate a pooled OR, with an associated 95% CI. ETHICS AND DISSEMINATION: This study is based on published data, and therefore ethical approval is not a requirement. Findings will be disseminated through publication in peer-reviewed journals and conference presentations at relevant conferences. TRIAL REGISTRATION NUMBER: CRD42015025755.