Abstract
BackgroundThis study aims to evaluate the outcomes of adults hospitalized for tuberculosis in a higher-income region with low HIV prevalence.MethodsA retrospective cohort study was conducted on all adults hospitalized for pulmonary and/or extrapulmonary tuberculosis in an acute-care hospital in Hong Kong during a two-year period. Microscopy and solid-medium culture were routinely performed. The diagnosis of tuberculosis was made by: (1) positive culture of M. tuberculosis, (2) positive M. tuberculosis PCR result, (3) histology findings of tuberculosis infection, and/or (4) typical clinico-radiological manifestations of tuberculosis which resolved after anti-TB treatment, in the absence of alternative diagnoses. Time to treatment (‘early’, started during initial admission; ‘late’, subsequent periods), reasons for delay, and short- and long-term survival were analyzed.ResultsAltogether 349 patients were studied [median(IQR) age 62(48–77) years; non-HIV immunocompromised conditions 36.7%; HIV/AIDS 2.0%]. 57.9%, 16.3%, and 25.8% had pulmonary, extrapulmonary, and pulmonary-extrapulmonary tuberculosis respectively. 58.2% was smear-negative; 0.6% multidrug-resistant. 43.4% developed hypoxemia. Crude 90-day and 1-year all-cause mortality was 13.8% and 24.1% respectively. 57.6% and 35.8% received ‘early’ and ‘late’ treatment respectively, latter mostly culture-guided [median(IQR) intervals, 5(3–9) vs. 43(25–61) days]. Diagnosis was unknown before death in 6.6%. Smear-negativity, malignancy, chronic lung diseases, and prior exposure to fluoroquinolones (adjusted-OR 10.6, 95%CI 1.3–85.2) delayed diagnosis of tuberculosis. Failure to receive ‘early’ treatment independently predicted higher mortality (Cox-model, adjusted-HR 1.8, 95%CI 1.1–3.0).ConclusionsMortality of hospitalized tuberculosis patients is high. Newer approaches incorporating methods for rapid diagnosis and initiation of anti-tuberculous treatment are urgently required to improve outcomes.
Highlights
The global burden of tuberculosis (TB) remains enormous, and TB continues to be a major cause of mortality worldwide [1,2]
HIV infection is a potent risk factor for development of active TB, 85–90% of TB cases were reported among HIVnegative persons [1,2]
The risk factors and the shortand long-term clinical outcomes of older, non-HIV patients hospitalized for severe TB infection remain unclear, in higher-income regions [7,8]
Summary
The global burden of tuberculosis (TB) remains enormous, and TB continues to be a major cause of mortality worldwide [1,2]. HIV infection is a potent risk factor for development of active TB, 85–90% of TB cases were reported among HIVnegative persons [1,2]. Most studies on outcomes of patients with active TB are reported from developing, lowerincome countries and regions with high HIV prevalence [3,4,5], and have largely involved younger adults with less severe infections not requiring hospital care [3,5,6]. The risk factors and the shortand long-term clinical outcomes of older, non-HIV patients hospitalized for severe TB infection remain unclear, in higher-income regions [7,8]. This study aims to evaluate the outcomes of adults hospitalized for tuberculosis in a higher-income region with low HIV prevalence
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