Abstract
Study objectives
To determine the factors associated with mortality after an in-hospital diagnosis of tuberculosis in a region with low levels of HIV coinfection.
Methods
From January 2003 to December 2004, all subjects who were > 15 years of age and had received a diagnosis of tuberculosis were registered. The clinical, radiological and laboratory aspects of the patients who died (n=27) were compared with those of an age and gender matched control population(n=54). Logistic regression analyses were carried out, which included age, gender, hospital admission source, initial site of admission, dyspnea, general weakness and initial laboratory data.
Results
The mean age of the patients was 60 ± 16 years and male patients outnumbered female patients. Univariate analysis identified hemoglobin, blood urea nitrogen, albumin, cholesterol, aspartate aminotransferase (AST), C-reactive protein and the risk factors for tuberculosis to be significantly associated with mortality. Among the characteristics of disease presentation and treatment, emergency department admission, intensive care unit, disease severity, general weakness and dyspnea at the time of admission were associated with mortality. Multiple regression analysis revealed the initial management in the intensive care unit and lower serum albumin to be independently associated with mortality.
Figures and Tables
References
1. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country: WHO Global Surveillance and Monitoring Project. JAMA. 1999. 282:677–686.
2. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006. 367:1747–1757.
3. Hansel NN, Wu AW, Chang B, Diette GB. Quality of life in tuberculosis: patient and provider perspectives. Qual Life Res. 2004. 13:639–652.
4. Rao VK, Iademarco EP, Fraser VJ, Kollef MH. The impact of comorbidity on mortality following in-hopital diagnosis of tuberculosis. Chest. 1998. 114:1244–1252.
5. Singleton L, Turner M, Haskal R, Etkind S, Tricarico M, Nardell E. Long-term hospitalization for tuberculosis control: experience with a medical-psychosocial inpatient unit. JAMA. 1997. 278:838–842.
6. Greenaway C, Menzies D, Fanning A, Grewal R, Yuan L, FitzGerald JM. Delay in diagnosis among hospitalized patietns with active tuberculosis: predictors and outcomes. Am J Respir Crit Care Med. 2002. 165:927–933.
7. Stoneburner R, Laroche E, Prevots R, Singh T, Blum S, Terry P, et al. Survival in a cohort of human immunodeficiency virus-infected tuberculosis patients in New York City. Arch Intern Med. 1992. 152:2033–2037.
8. Goble M, Iseman MD, Madsen LA, Madsen LA, Waite D, Ackerson L, et al. Treatment of 171 patients with pulmonary tuberculosis resistant to isonizid and rifampin. N Engl J Med. 1993. 328:527–532.
9. Park MM, Davis AL, Schluger NW, Cohen H, Rom WN. Outcome of MDR-TB patients, 1983-1993: prolonged survival with appropriate therapy. Am J Respir Crit Care Med. 1996. 153:317–324.
10. Pablos-Mendez A, Sterling TR, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA. 1996. 276:1223–1228.
11. Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2005. 9:777–783.
12. Fang HC, Lee PT, Chen CL, Wu MJ, Chou KJ, Chung HM. Tuberculosis in patients with end-stage renal disease. Int J Tuberc Lung Dis. 2004. 8:92–97.
13. Mehta JB, Fields CL, Byrd RP Jr, Roy TM. Nutritional status and mortality in respiratory failure caused by tuberculosis. Tenn Med. 1996. 89:369–371.
14. Lee PL, Jerng JS, Chang YL, Chen CF, Hsueh PR, Yu CJ, et al. Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation. Eur Respir J. 2003. 22:141–147.
15. Penner C, Roberts D, Kunimoto D, Manfreda J, Long R. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med. 1995. 151:867–872.
16. Frame RN, Johnson MC, Eichenhorn MS, Bower GC, Popovich J Jr. Active tuberculosis in the medical intensive care units: a 15-year retrospective analysis. Crit Care Med. 1987. 15:1012–1014.
17. Pompei P, Charlson ME, Ales K, MacKenzie CR, Norton M. Relating patient characteristics at the time admission to outcome of hospitalization. J Clin Epidemiol. 1991. 44:1063–1069.
18. Greenfield S, Aronow HU, Elashoff RM, Watanabe D. Flaws in mortality data: the hazards of ignoring comorbid disease. JAMA. 1988. 260:2253–2255.
19. Hansel NN, Merriman B, Haponik EF, Diette GB. Hospitalization for tuberculosis in the United States in 2000: predictors of in-hospital mortality. Chest. 2004. 126:1079–1086.