Factors Associated with In-Hospital Mortality of Smear-positive Pulmonary Tuberculosis

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Jeerawat Kaewwinud

Abstract

Background: Tuberculosis(TB) is a preventable and curable disease. Despite the comprehensive care and proper anti-tuberculous drug, mortality remains high among tuberculosis patient. Thailand is one of high TB burden country which mortality rate is in the 9th of Asia. Similar to the data of Surin hospital, which the mortality rate was increased every year. The aim of this study is to identify the risk factors associated with death in smear-positive pulmonary tuberculosis who were hospitalized in Surin hospital, Thailand.
Methods: A retrospective cross-sectional review was conducted. Smear positive pulmonary TB patient admitted to Surin Hospital from January 2015 to June 2017 was reviewed. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors for TB mortality.
Results: Of the 303 TB admission (292 patients) reviewed, 91 patients (30%)died during TB admission. About eighty-eightpercent of the TB deaths occurred in the intensive phase of the treatment. In univariate analysis, the main risk factors for TB mortality were female(OR,1.86 (1.08, 3.19)), presenting symptom as fever(OR, 2.4; (1.36, 4.31)), dyspnea(OR,4.76; (2.7, 8.47)), stuporous(OR, 3.02; (1.3, 7.01) initial septic shock (OR, 16.69; (7.03, 43.5)), late septic shock (OR, 29.58; (6.83, 264.11)), drug-induced hepatitis (OR, 2.03; (0.97, 4.18)), complication as acute kidney injury (OR, 13.01; (4.89, 40.04)), hospital-acquired pneumonia (OR, 7.18; (2.85, 19.58)) In multivariate analysis, pulmonary TB with tuberculous meningitis (adjusted OR, 653.19; (3.33, 128307.03)), multilobar infiltration (adjusted OR, 21.18; (1.71, 262.14)) and acute respiratory failure (adjusted OR, 97.99; (11.45, 838.8)) are significantly increased risk of death.
Conclusion: Acute respiratory failure is the main risk factor for death, to improve TB mortality, we should focus more on the management of the critical respiratory care.
Keywords: death, mortality, risk factors, smear positive pulmonary tuberculosis

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