Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment.

T Rodrigo,M A Jiménez-Fuentes,J P Millet,J Caylá,J A Caminero,J F Medina,M Casals,J Ruiz-Manzano,J M García-García,Sanjay Haresh Chotirmall

doi:10.1371/journal.pone.0159925

Abstract

ObjectiveTo determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality.MethodsTB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI).ResultsA total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8–283.4); being retired (HR = 2.4;CI:1.1–5.1); having visited the emergency department (HR = 3.1;CI:1.2–7.7); HIV infection (HR = 3.4;CI:1.6–7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2–3.3) or non-standard treatments (HR = 2.68;CI:1.36–5.25); comprehension difficulties (HR = 2.8;CI:1.3–6.1); and smear-positive sputum (HR = 2.3-CI:1.0–4.8).ConclusionThere is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs.

Highlights

Tuberculosis (TB) is a curable disease and is considered to be a cause of unnecessarily premature and avoidable deaths [1] that should be eradicated as a cause of death [2]
The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;confidence intervals (CI):4.8–283.4); being retired (HR = 2.4; CI:1.1–5.1); having visited the emergency department (HR = 3.1;CI:1.2–7.7); HIV infection
SEPAR and the International Union Against Tuberculosis and Lung Disease did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript

Summary

Introduction

Tuberculosis (TB) is a curable disease and is considered to be a cause of unnecessarily premature and avoidable deaths [1] that should be eradicated as a cause of death [2]. While global TB mortality is estimated to have decreased by 45% between 1990 and 2013, it was still the cause of 1.5 million deaths in 2014, more than the number caused by HIV (1.2 million) [3]. Mortality among TB patients varies considerably between countries. Other studies indicate mortality of 6.6% in the United States and Canada [8], 5.5% in Shangai [9], 12% in Rwanda [10], 18% in the Chiapas region of Mexico [11], 19.7% in Taiwan [12], and 26.6% in Pakistan [13]. There is little data on mortality and survival among TB patients, and a recently European study on the topic [6] indicated that no information was available for Spain

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Results

Conclusion