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Abstract
BackgroundDespite effective anti-TB treatments, tuberculosis remains a serious threat to public health and is associated with high mortality. Old age and multiple co-morbidities are known risk factors for death. The association of clinical presentations with mortality in pulmonary tuberculosis patients remains an issue of controversy.MethodsThis prospective observational study enrolled newly diagnosed, culture-proven pulmonary tuberculosis patients from five medical centers and one regional hospital, which were referral hospitals of TB patients. Radiographic findings and clinical symptoms were determined at the time of diagnosis. Patients who died for any reason during the course of anti-TB treatment were defined as mortality cases and death that occurred within 30 days of initiating treatment was defined as early mortality. Clinical factors associated with overall mortality and early mortality were investigated.ResultsA total of 992 patients were enrolled and 195 (19.7%) died. Nearly one-third (62/195, 31.8%) of the deaths occurred before or within 30 days of treatment initiation. Older age (RR = 1.04, 95%CI: 1.03–1.05), malignancy (RR = 2.42, 95%CI: 1.77–3.31), renal insufficiency (RR = 1.77, 95%CI: 1.12–2.80), presence of chronic cough (RR = 0.63, 95%CI: 0.47–0.84), fever (RR = 1.45, 95%CI: 1.09–1.94), and anorexia (RR = 1.49, 95%CI: 1.07–2.06) were independently associated with overall mortality. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients present with fever (p<0.001), anorexia (p = 0.005), and without chronic cough (p<0.001). Among patients of mortality, those with respiratory symptoms of chronic cough (RR = 0.56, 95%CI: 0.33–0.98) and dyspnea (HR = 0.51, 95%CI: 0.27–0.98) were less likely to experience early mortality. The radiological features were comparable between survivors and non-survivors.ConclusionsIn addition to demographic characteristics, clinical presentations including the presence of fever, anorexia, and the absence of chronic cough, were also independent predictors for on-treatment mortality in pulmonary tuberculosis patients.
Highlights
Pulmonary tuberculosis (PTB) is an infectious disease with airborne transmission that is associated with high morbidity and mortality worldwide
Despite the advances in anti-tuberculosis medications and the use of a Direct Observation Therapy/Short Course (DOTS) strategy, the tuberculosis mortality rates remain high in many areas, including Taiwan [1,2,3,4]
992 patients with newly diagnosed, culture-proved pulmonary tuberculosis were included for analysis
Summary
Pulmonary tuberculosis (PTB) is an infectious disease with airborne transmission that is associated with high morbidity and mortality worldwide. Age and underlying co-morbidities have been frequently reported as independent predictors of mortality in previous studies [4,5,6]. Studies that evaluated the impacts of drug susceptibility profiles on mortality reported controversial results [3,6]. Most of these predictors of mortality were nonmodifiable factors. Despite effective anti-TB treatments, tuberculosis remains a serious threat to public health and is associated with high mortality. The association of clinical presentations with mortality in pulmonary tuberculosis patients remains an issue of controversy
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