Treatment options and outcomes of hospitalised tuberculosis patients: a nationwide study.

Abstract

Although standardised multidrug treatments exist, mortality among hospitalised tuberculosis (TB) patients is high. To characterise TB patients requiring acute hospital care and identify factors associated with in-hospital mortality. Using a Japanese national database of acute-care hospitals, we identified patients with sputum smear-positive pulmonary TB who were discharged (both deceased and alive) between July 2010 and March 2013. Demographic characteristics, comorbidity, procedures and treatments were examined. We performed a multivariable logistic regression analysis to identify risk factors for in-hospital mortality. Of 877 treated patients (566 males, mean age 74.5 years) identified, 152 (17.3%) died. A standard four-drug regimen of isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide was given to 279 (31.8%) patients, and INH, RMP and EMB to 335 (38.2%) patients. Multivariable analysis showed that the three-drug regimen was significantly associated with higher rates of in-hospital mortality (OR 1.87, 95%CI 1.07-3.27, P = 0.028). Other factors associated with in-hospital death were age, male sex, smoking habit, emergency admission, dementia and severe respiratory condition. The risk factors for in-hospital death identified include the use of the three-drug regimen. Treatment choice could influence the outcome of hospitalised TB patients.