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

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Jeerawat Kaewwinud


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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1. World Health Organization. Global tuberculosis report 2018. [Internet]. 2018. [cited 2018 Jan 15]. Available: https://www.who.int/tb/publications/global_report/en/.

2. World Health Organization. Global tuberculosis report 2017. [Internet]. 2017. [cited 2018 Dec 7]. Available: https://www.searo.who.int/tb/documents/annual_tb_repot_2017/en/.

3. Alavi-Naini R, Moghtaderi A, Metanat M, Mohammadi M, Zabetian M. Factors associated with mortality in tuberculosis patients. J Res Med Sci 2013;18(1):52-5.

4. Kim CW, Kim S-H, Lee SN, Lee MK, Lee J, Shinn KC, et al. Risk factors related with mortality in patient with pulmonary tuberculosis. Tuberc Respir Dis (Seoul) 2012;73(1):38-47.

5. Sun J, Fang K, Ren DH, Sheng XL. A study of the prognostic factors associated with mortality in critically ill patients with tuberculous. Zhonghua Jie He He Hu Xi Za Zhi 2011; 34(1):39-42.

6. Kim HJ, Lee CH, Shin S, Lee JH, Kim YW, Chung HS, et al. The impact of nutritional deficit on mortality of in-patients with pulmonary tuberculosis. Int J Tuberc Lung Dis 2010;14(1):79-85.

7. Horita N, Miyazawa N, Yoshiyama T, Sato T, Yamamoto M, Tomaru K, et al. Development and validation of a tuberculosis prognostic score for smear-positive in-patients in Japan. Int J Tuberc Lung Dis 2013;17(1):54-60.

8. Okamura K, Nagata N, Wakamatsu K, Yonemoto K, Ikegame S, Kajiki A, et al. Hypoalbuminemia and lymphocytopenia are predictive risk factors for in-hospital mortality in patients with tuberculosis. Intern Med 2013;52(4):439-44.

9. Lubart E, Lidgi M, Leibovitz A, Rabinovitz C, Segal R. Mortality of patients hospitalized for active tuberculosis in Israel. Isr Med Assoc J 2007;9(12):870-3.

10. Ryu YJ, Koh WJ, Kang EH, Suh GY, Chung MP, Kim H, et al. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology 2007;12(3):406-11.

11. 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(1):141-7.

12. Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J 2006;27(6):1223-8.

13. Lin SM, Wang TY, Liu WT, Chang CC, Lin HC, Liu CY, et al. Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure. Int J Tuberc Lung Dis 2009;13(3):335-40.

14. Erhabor GE, Adewole OO, Ogunlade O. A five-year review of tuberculosis mortality amongst hospitalised patients in Ile-Ife. Indian J Chest Dis Allied Sci 2006;48(4):253-6.

15. Liew SM, Khoo EM, Ho BK, Lee YK, Mimi O, Fazlina MY, et al. Tuberculosis in Malaysia: Predictors of treatment outcomes in a national registry. Int J Tuberc Lung Dis 2015;19(7):764-71.

16. สำนักวัณโรค กรมควบคุมโรค กระทรวงสาธารณสุข. ผลการดำเนินงานควบคุมวัณโรคเขตสุขภาพที่ 9 ปี 2557- 2560 เอกสารอิเล็กโทรนิคส์. [สืบค้นข้อมูลวันที่ 12 มีนาคม 2561]. www.tbcmthailand.net.

17. de Almeida CPB, Ziegelmann PK, Couban R, Wang L, Busse JW, Silva DR. Predictors of in-hospital mortality among patients with pulmonary tuberculosis: A Systematic Review and Meta-analysis. Sci Rep 2018;8(1):7230.

18. Gaifer ZA. Risk factors for tuberculosis mortality in a tertiary care center in Oman 2006–2016. Int J Mycobacteriol 2017;6(4):356-9.

19. Sacks LV., Pendle S. Factors related to in-hospital deaths in patients with tuberculosis. Arch Intern Med 1998;158(17):1916–22.

20. Loh WJ, Yu Y, Loo CM, Low SY. Factors associated with mortality among patients with active pulmonary tuberculosis requiring intensive care. Singapore Med J 2017;58(11):656-9.

21. Marcy O, Laureillard D, Madec Y, Chan S, Mayaud C, Borand L, et al. Causes and determinants of mortality in HIV-infected adults with tuberculosis: An analysis from the CAMELIA ANRS 1295-CIPRAKH001 randomized trial. Clin Infect Dis 2014;59(3):435-45.

22. Tabarsi P, Chitsaz E, Moradi A, Baghaei P, Farnia P, Marjani M, et al. Treatment outcome, mortality and their predictors among HIV-associated tuberculosis patients. Int J STD AIDS 2012;23(9):e1-4.