Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis

Background Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings. Methods Retrospective chart review of patients w...

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Published in:BMC infectious diseases Vol. 11; no. 1; p. 1
Main Authors: Nahid, Payam, Jarlsberg, Leah G, Rudoy, Irina, de Jong, Bouke C, Unger, Alon, Kawamura, L Masae, Osmond, Dennis H, Hopewell, Philip C, Daley, Charles L
Format: Journal Article
Language:English
Published: London BioMed Central 03.01.2011
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antitubercular Agents - therapeutic use
California
Care and treatment
Drug resistance
Female
HIV
Human immunodeficiency virus
Humans
Infectious Diseases
Internal Medicine
Male
Medical Microbiology
Medicine
Medicine & Public Health
Middle Aged
Mortality
Multivariate analysis
Mycobacterium
Parasitology
Patient Compliance
Patient outcomes
Pulmonary tuberculosis
Research Article
Retrospective Studies
Risk factors
San Francisco
Side effects
Treatment Outcome
Tropical Medicine
Tuberculosis
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - immunology
Tuberculosis, Pulmonary - mortality
Tuberculosis, Pulmonary - psychology
Young Adult
San Francisco
California
United States > US
San Francisco California
Tuberculosis Treatment
Sputum Smear
Directly Observe Therapy
Tuberculosis
Acid Fast Bacillus
ISSN:1471-2334, 1471-2334
Online Access:Get full text
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Summary:Background Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings. Methods Retrospective chart review of patients with drug-susceptible tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001. Results Of 565 patients meeting eligibility criteria, 37 (6.6%) died during the study period. Of 37 deaths, 12 (32.4%) had tuberculosis listed as a contributing factor. In multivariate analysis controlling for follow-up time, four characteristics were independently associated with mortality: HIV co-infection (HR = 2.57, p = 0.02), older age at tuberculosis diagnosis (HR = 1.52 per 10 years, p = 0.001); initial sputum smear positive for acid fast bacilli (HR = 3.07, p = 0.004); and experiencing an interruption in tuberculosis therapy (HR = 3.15, p = 0.002). The association between treatment interruption and risk of death was due to non-adherence during the intensive phase of treatment (HR = 3.20, p = 0.001). The median duration of treatment interruption did not differ significantly in either intensive or continuation phases between those who died and survived (23 versus 18 days, and 37 versus 29 days, respectively). No deaths were directly attributed to adverse drug reactions. Conclusions In addition to advanced age, HIV and characteristics of advanced tuberculosis, experiencing an interruption in anti-tuberculosis therapy, primarily due to non-adherence, was also independently associated with increased risk of death. Improving adherence early during treatment for tuberculosis may both improve tuberculosis outcomes as well as decrease mortality.
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ISSN:1471-2334
1471-2334
DOI:10.1186/1471-2334-11-1