Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study

Inge K Holden,Troels Lillebaek,Christian Wejse,Peter H Andersen,Isik S Johansen,Joan A Caylà

doi:10.1371/journal.pone.0231821

Inge K Holden, Troels Lillebaek + Show 4 more

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https://doi.org/10.1371/journal.pone.0231821

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Abstract

ObjectivesMortality from tuberculosis (TB) has been declining since 2000, nevertheless there is still a significant number of patients who die before or during TB treatment. The aims were to examine and describe predictors associated with TB related mortality.MethodsPatients notified with TB from 2009 though 2014 in Denmark were included. Data were extracted from national registers and patient records were examined for clinical information and treatment outcome. Cox proportional hazards regression was used to examine TB related mortality.ResultsA total of 2131 cases were identified, 141 (6.6%) patients died before or during TB treatment. TB related mortality accounted for 104 cases (73.8%) and decreased significantly from 6.7% to 3.2% (p = .04) during the study period. Within 1 months of diagnosis, 49% of TB related deaths had occurred. The strongest risk factors present at time of diagnosis, associated with TB related mortality, were: age > 70 years, Charlson comorbidity index > 1, alcohol abuse, weight loss, anemia, and C-reactive protein > 100 mg/L (p < .05).ConclusionThe majority of TB related deaths occurred soon after diagnosis, emphasizing that TB patients identified to have a high risk of mortality should be closely monitored before and during the intensive treatment period to improve their outcomes.

Highlights

From 2000 to 2016, the mortality rate of tuberculosis (TB) has been declining with the greatest decline observed in Western Europe
TB related mortality accounted for 104 cases (73.8%) and decreased significantly from 6.7% to 3.2% (p = .04) during the study period
The majority of TB related deaths occurred soon after diagnosis, emphasizing that TB patients identified to have a high risk of mortality should be closely monitored before and during the intensive treatment period to improve their outcomes

Summary

Introduction

From 2000 to 2016, the mortality rate of tuberculosis (TB) has been declining with the greatest decline observed in Western Europe. TB remains the number one cause of death among infectious diseases in people older than 5 years. The proportion of people with TB who dies varies from less than 5% in Western Europe to more than 20% in Sub-Saharan Africa [1]. Earlier Danish studies have demonstrated increased long term mortality in TB patients, and a recent Danish study, found the overall hazard ratio of death was 2.45 during two year follow up [2, 3]. The study identified increasing age and increasing number of comorbidities to be associated with mortality. It was register-based and did not include clinical information. There are no recent Danish studies examining the clinical risk factors associated with mortality before and during TB treatment

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