Mortality In Tuberculosis Patients Research Articles

Excess fermentation and lactic acidosis as detrimental functions of the gut microbes in treatment-naive TB patients.

The link between gut microbiota and host immunity motivated numerous studies of the gut microbiome in tuberculosis (TB) patients. However, these studies did not explore the metabolic capacity of the gut community, which is a key axis of impact on the host's immunity. We used deep sequencing of fecal samples from 23 treatment-naive TB patients and 48 healthy donors to reconstruct the gut microbiome's metabolic capacity and strain/species-level content. We show that the systematic depletion of the commensal flora of the large intestine, Bacteroidetes, and an increase in Actinobacteria, Firmicutes, and Proteobacteria such as Streptococcaceae, Erysipelotrichaceae, Lachnospiraceae, and Enterobacteriaceae explains the strong taxonomic divergence of the gut community in TB patients. The cumulative expansion of diverse disease-associated pathobionts in patients reached 1/4 of the total gut microbiota, suggesting a heavy toll on host immunity along with MTB infection. Reconstruction of metabolic pathways showed that the microbial community in patients shifted toward rapid growth using glycolysis and excess fermentation to produce acetate and lactate. Higher glucose availability in the intestine likely drives fermentation to lactate and growth, causing acidosis and endotoxemia. Excessive fermentation and lactic acidosis likely characterize TB patients' disturbed gut microbiomes. Since lactic acidosis strongly suppresses the normal gut flora, directly interferes with macrophage function, and is linked to mortality in TB patients, our findings highlight gut lactate acidosis as a novel research focus. If confirmed, gut acidosis may be a novel potential host-directed treatment target to augment traditional TB treatment.

Relationship between metformin use and mortality in tuberculosis patients with diabetes: a nationwide cohort study.

To determine whether metformin, which is considered a host-directed therapy for tuberculosis (TB), is effective in improving the prognosis of patients with TB and diabetes mellitus (DM), who have higher mortality than those without DM. This cohort study included patients who were registered as having TB in the National Tuberculosis Surveillance System. The medical and death records of matched patients were obtained from the National Health Information Database and Statistics Korea, respectively, and data from 2011 to 2017 were collected retrospectively. We classified patients according to metformin use among participants who used diabetes drugs for more than 28 days. The primary outcome was all-cause mortality during TB treatment. Double propensity score adjustment was applied to reduce the effects of confounding and multivariable Cox proportional hazard models were used to estimate adjusted hazard ratio (aHR) with 95% confidence interval (CI). The all-cause mortality rate during TB treatment was lower (9.5% vs. 12.4%, p < 0.01) in the metformin user group. The hazard of death due to all causes after double propensity score adjustment was also lower in the metformin user group (aHR 0.76, 95% CI 0.67-0.86, p < 0.01). There was no significant difference in mortality between metformin users and non-users for TB-related deaths (p = 0.22); however, there was a significant difference in the non-TB-related deaths (p < 0.01). Metformin use in patients with TB-DM co-prevalence is associated with reduced all-cause mortality, suggesting the potential for metformin adjuvant therapy in these patients.

Mortality of tuberculosis patients through associated diseases and other causes

Purpose. Study of the mortality of tuberculosis patients by associated diseases and other causes. Materials and methods. A comparative, retrospective analysis of 222 cases of death due to tuberculosis, associated diseases and other causes in the municipality of Chisinau in two time periods was carried out: period I (2001-2003) - 157 and period II (2018-2020) - 65 cases. Results. In period II, compared to period I, there was a shift in age towards 65+ (over 1/3 of cases); approximately ½ cases of deaths were from retreatment cases; the infiltrative form of tuberculosis predominated; increased oncological pathology; the number of liver diseases has decreased, there have been cases of death after perforating gastric ulcer and COVID-19. In both periods, patients also died from other causes: In period I – septicemia – 2; road accidents -15, freezing - 8 and suicides - 2 cases; In period II- peritonitis -2, drowning - 2, frostbite - 2, drug overdose - 2 and suicide - 1 case. Conclusion. The most common associated diseases that contributed to the death of tuberculosis patients were: oncological pathology, diseases of the cardiac system, cerebral stroke.

Factors associated with all-cause mortality in tuberculosis patients in a Malaysian tertiary hospital.

The all-cause mortality for tuberculosis is 1 in every 10 patients in Malaysia. The currently available national surveillance database does not record patients' variables such as socio-economic factors, existing co-morbidities, and risk behavior for investigation. An electronic medical record system can capture this missing information and use it to determine all-cause mortality factors more accurately. Our study aims to determine the factors associated with all-cause mortality in a cohort of tuberculosis patients in a Malaysian tertiary hospital which is equipped with an electronic medical record system. Records of patients diagnosed with tuberculosis from 1st January 2018 to 30th September 2019 were retrieved. Sociodemographic and clinical data were extracted. Treatment outcomes and all-cause mortality were recorded at 1 year after diagnosis. Univariate, multivariate, and stepwise regression were used to determine the factors associated with all-cause mortality. Four-hundred and seventy-one patients were reviewed. The mean age was 46.6 ± 19.7 years. The all-cause mortality rate at one year of diagnosis was 15.3%. Factors identified were age [aOR 1.026 (95% CI: 1.004-1.049)], chronic kidney disease [aOR 3.269 (1.508-7.088)], HIV positive status [aOR 4.743 (1.505-14.953)], active cancer [aOR 5.758 (1.605-20.652)], liver disease [aOR 6.220 (1.028-37.621)], and moderate to advanced chest X-ray findings [aOR 3.851 (1.033-14.354)]. On average, one in seven patients diagnosed with TB died within a year in a Malaysian tertiary hospital. Identification of this vulnerable group using the associated factors found in this study may help to reduce the risk of mortality through early intervention strategies.

Relationship between the thickness of erector spinae muscles and mortality in patients with pulmonary tuberculosis

BackgroundSkeletal muscle mass is a known predictor of mortality in older patients. However, its relationship with tuberculosis is unclear. Skeletal muscle mass is determined by the cross-sectional area of erector spinae muscle (ESMCSA). Additionally, the erector spinae muscle thickness (ESMT) is an easier measurement than ESMCSA. This study investigated the relationship of ESMT and ESMCSA with mortality in tuberculosis patients. MethodsWe retrospectively collected the data of 267 older patients (age ≥65 years) who were hospitalized due to tuberculosis at the Fukujuji Hospital from January 2019 to July 2021. This included 40 patients with 60-day mortality (the death group) and 227 patients with 60-day survival (the alive group). Here, we assessed the correlations between ESMCSA and ESMT, and the data were compared between the two groups. ResultsESMT had a strong proportional relationship with ESMCSA (r = 0.991, p < 0.001). ESMCSA (median 670.2 mm2 [interquartile range (IQR): 585.1–760.9] vs. 914.3 mm2 [717.6–1141.6], p < 0.001) and ESMT (median 16.7 mm [15.4–18.6] vs. 21.1 mm [18.0–25.5], p < 0.001) were significantly lower in the patients in the death group than those of patients in the alive group. A multivariable Cox proportional hazard model for 60-day mortality showed significantly independent differences in ESMT (hazard ratio [HR] 0.870 [95% confidence interval (Cl): 0.795–0.952], p = 0.003) and ESMCSA (HR 0.998 [95% Cl: 0.996–0.999], p = 0.009). ConclusionsThis study demonstrated a strong correlation between ESMCSA and ESMT, which were risk factors for mortality in patients with tuberculosis. Therefore, using ESMT is easier to predict mortality than ESMCSA.

Hepatitis B and C virus infections and associated factors among HIV-positive and HIV-negative tuberculosis patients in public health facilities, Northeast Ethiopia: A comparative cross-sectional study.

Viral hepatitis, particularly hepatitis B virus and hepatitis C virus, is the leading cause of global liver-related morbidity and mortality. Concomitant infections of hepatitis B virus, hepatitis C virus, and tuberculosis are risks of hepatotoxicity and death due to antituberculosis therapy. Hepatitis and human immunodeficiency virus coinfection poses challenges in treating hepatotoxic patients and leads to mortality during antituberculosis treatment. Thus, this study aimed to determine the prevalence of hepatitis B virus and hepatitis C virus infections, and associated factors among human immunodeficiency virus-positive and human immunodeficiency virus-negative tuberculosis patients attending public health facilities, Northeast Ethiopia. A comparative cross-sectional study was conducted among 229 tuberculosis patients from January 1 to April 30, 2021 in public health facilities' tuberculosis treatment centers. Study participants were selected using a consecutive sampling technique. Data on sociodemographic and other risk factors were collected using an interviewer-based pretested questionnaire by trained data collectors. Anti-hepatitis C virus and hepatitis B surface antigen were determined in serum using enzyme-linked immunosorbent assay. Data were entered and analyzed using SPSS version 22. Logistic regression analysis was computed, and then variables with a p value <0.05 were considered as statistically significant. The overall hepatitis virus infection among human immunodeficiency virus-positive and human immunodeficiency virus-negative tuberculosis patients was 14.03% and 8.14%, respectively. The prevalence of hepatitis B virus infection in human immunodeficiency virus positives and human immunodeficiency virus negatives was 10.5% and 6.4% and hepatitis C virus infection in human immunodeficiency virus positives and human immunodeficiency virus negatives was 3.5% and 1.75%, respectively. Hepatitis B virus and hepatitis C virus coinfections were not observed. Older age, history of problematic alcohol use, history of blood transfusion, ear-noise piercing, and history of multiple heterosexual partners were predictors for the hepatitis virus infection. Hepatitis virus infection increases morbidity and mortality of tuberculosis patients. Therefore, screening tuberculosis patients for hepatitis virus infection is necessary to reduce the risk of antituberculosis complications.

EPH2 Development and Validation of Clinical Prediction Score of Mortality in Tuberculosis Patients

EPH2 Development and Validation of Clinical Prediction Score of Mortality in Tuberculosis Patients

Characteristics of tuberculosis-related deaths and risk factors: a retrospective cohort study in Samsun province of Turkey

ABSTRACT Objectives Tuberculosis (TB) remains one of the top ten leading causes of death worldwide despite effective therapy. The present study aims to examine the characteristics of TB-related deaths in Samsun Province and to determine the risk factors. Methods In this retrospective registry-based cohort study, the medical records of patients registered with Samsun Tuberculosis Control Dispensary between 1 January 2018 and 31 December 2019 were retrospectively reviewed. The Cox proportional-hazards model was used to determine the factors associated with the risk of death in patients with TB. Results The treatment outcomes of a total of 382 patients were reviewed. It was found that the treatment was successful in 346 patients (90.6%), and 31 patients (8.1%) died before or during TB therapy. The median survival time of patients who died during the therapy was 1.86 months (95% CI = 0.07–5.17 months), and more than 50% (13/25) of the deaths occurred in the first two months of the treatment. Age above 70 years (HR 15.06 (3.33–67.95)), male gender (HR 2.74 (1.02–7.33)), pulmonary TB (HR 2.92 (1.002–8.52)), multidrug-resistant (MDR) tuberculosis (HR 1.69 (1.22–12.75)), and a delay in the treatment of more than ten days (HR 2.71 (1.22–6.04)) were identified as risk factors associated with mortality in TB patients (p < 0.05). Conclusion The majority of deaths in our cohort occurred within the first two months after starting the treatment. Advanced age, male sex, a new diagnosis of TB, pulmonary TB, MDR-TB, and a treatment delay of more than ten days after diagnosis increased the risk for mortality during antituberculosis treatment.

Early mortality in tuberculosis patients initially lost to follow up following diagnosis in provincial hospitals and primary health care facilities in Western Cape, South Africa.

In South Africa, low tuberculosis (TB) treatment coverage and high TB case fatality remain important challenges. Following TB diagnosis, patients must link with a primary health care (PHC) facility for initiation or continuation of antituberculosis treatment and TB registration. We aimed to evaluate mortality among TB patients who did not link to a TB treatment facility for TB treatment within 30 days of their TB diagnosis, i.e. who were "initial loss to follow-up (ILTFU)" in Cape Town, South Africa. We prospectively included all patients with a routine laboratory or clinical diagnosis of TB made at PHC or hospital level in Khayelitsha and Tygerberg sub-districts in Cape Town, using routine TB data from an integrated provincial health data centre between October 2018 and March 2020. Overall, 74% (10,208/13,736) of TB patients were diagnosed at PHC facilities and ILTFU was 20.0% (2,742/13,736). Of ILTFU patients, 17.1% (468/2,742) died, with 69.7% (326/468) of deaths occurring within 30 days of diagnosis. Most ILTFU deaths (85.5%; 400/468) occurred in patients diagnosed in hospital. Multivariable logistic regression identified increasing age, HIV positive status, and hospital-based TB diagnosis (higher in the absence of TB treatment initiation and being ILTFU) as predictors of mortality. Although hospitals account for a modest proportion of diagnosed TB patients they have high TB-associated mortality. A hospital-based TB diagnosis is a critical opportunity to identify those at high risk of early and overall mortality. Interventions to diagnose TB before hospital admission, improve linkage to TB treatment following diagnosis, and reduce mortality in hospital-diagnosed TB patients should be prioritised.

Risk factors for death in tuberculosis patients requiring ICU care.

The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7-0.9) per 1 g/l and 1.1 (95% CI: 1.0-1.2) per 1 × 109/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.

The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes

Hypertension induces systemic inflammation, but its impact on the outcome of infectious diseases like tuberculosis (TB) is unknown. Calcium channel blockers (CCB) improve TB treatment outcomes in preclinical models, but their effect in patients with TB remain unclear. This retrospective cohort study, including all patients > 18 years receiving treatment for culture-confirmed, drug-sensitive TB from 2000 to 2016 at the National Taiwan University Hospital, assessed the association of hypertension and CCB use with all-cause and infection-related mortality during the first 9 months of TB treatment, as well as sputum smear microscopy and sputum culture positivity at 2 and 6 months. Of the 2894 patients, 1052 (36.4%) had hypertension. A multivariable analysis revealed that hypertension was associated with increased mortality due to all causes (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.23-1.99) and infections (HR, 1.87; 95% CI, 1.34-2.6), but there were no statistical differences in microbiological outcomes when stratified based on hypertensive group. Dihydropyridine-CCB (DHP-CCB) use was associated only with reduced all-cause mortality (HR, 0.67; 95% CI, .45-.98) by univariable Cox regression. There were no associations between DHP-CCB use and infection-related mortality (HR, 0.78; 95% CI, .46-1.34) or microbiological outcomes in univariable or multivariable regression analyses. Patients with hypertension have increased all-cause mortality and infection-related mortality during the 9 months following TB treatment initiation. DHP-CCB use may lower all-cause mortality in TB patients with hypertension. The presence of hypertension or the use of CCB did not result in a significant change in microbiological outcomes.

Long-term mortality of patients with tuberculosis in Korea.

BACKGROUND: Long-term mortality following tuberculosis (TB) diagnosis in Korea remains unclear.METHODS: The present study used data from the National Health Insurance Service database, an extensive health-related database including most Korean residents. TB patients were identified using International Classification of Diseases, Tenth Revision coding (A15-19, U88.0-88.1) and the type of anti-TB drug(s) between 2003 and 2016. Long-term mortality and causes of death in TB patients were analysed.RESULTS: A total of 357 211 individuals had TB over the period from 2003 to 2016 and 103 682 died. The mean age of the cohort was 54.7 ± 20.7 years, and 59.8% were male. The survival probability of TB patients at 1, 5, and 10 years after diagnosis was 87.8%, 75.3%, and 63.3%, respectively. High mortality and TB-related death rates were especially prominent in the early stages after TB diagnosis. The overall standardized mortality ratio of TB patients to the general Korean population was 3.23 (95% confidence interval 3.21-3.25).CONCLUSION: Mortality in TB patients was especially high in the early stages of disease after TB diagnosis, and mostly due to TB. This figure was approximately three-times higher than the mortality rate in the general population.

Trends and risk factors for death and excess all-cause mortality among notified tuberculosis patients in the UK: an analysis of surveillance data.

IntroductionIn the UK, several hundred patients notified with tuberculosis (TB) die every year. The aim of this article is to describe trends in deaths among notified TB patients, explore risk factors associated with death and compare all-cause mortality in TB patients with age-specific mortality rates in the general UK population.MethodsWe used 2001–2014 data from UK national TB surveillance to explore trends and risk factors for death, and population mortality data to compare age-specific death rates among notified TB patients with annual death rates in the UK general population.ResultsThe proportion of TB patients in the UK who died each year declined steadily from 7.1% in 2002 to 5.5% in 2014. One in five patients (21.3%) was diagnosed with TB post-mortem. Where information was available, almost half of the deaths occurred within 2 months of starting treatment. Risk factors for death included demographic, disease-specific and social risk factors. Age had by far the largest effect, with patients aged ≥80 years having a 70 times increased risk of death compared with those aged <15 years. In contrast, excess mortality determined by incidence ratios comparing all-cause mortality among TB patients with that of the general population was highest among children and the working-age population (15–64 years old).ConclusionsEfforts to control TB and improve diagnosis and treatment outcomes in the UK need to be sustained. Control efforts need to focus on socially deprived and vulnerable groups. There is a need for further in-depth analysis of deaths of TB patients in the UK to identify potentially preventable factors.

Social Determinants Associated with Tuberculosis Mortality in a General Hospital in Mexico

Background:Most TB deaths can be prevented with timely diagnosis and appropriate treatment. In fact, millions of people are diagnosed and treated successfully every year, avoiding millions of deaths. However, globally, there are still huge gaps in detection and treatment.Objective:To identify the social determinants associated with mortality due to TB in a general hospital in Mexico.Methodology:All patients admitted with a diagnosis of pulmonary tuberculosis to the Emergency Department of a hospital in Mexico were included during a 10-month period. At the end of the study, the condition of discharge of all cases was obtained from the electronic database of the State Tuberculosis Program.Results:One-hundred and twenty-four patients with tuberculosis were included in the sample. Thirty-eight patients (30.6%) died during their hospital stay and eleven (8.9%) died outside the hospital after their discharge, for a total of 49 (39.5%) deaths. Of the 29 patients with HIV/AIDS, 12 died (41.3%). Logistic regression analysis showed that older age, imprisonment, and previous tuberculosis were significant predictors of mortality.Conclusion:The mortality of tuberculosis patients diagnosed in HGT is very high, mainly because the diagnosis is established at the hospital level, which implies a late diagnosis.

Diabetic trends and associated mortality in tuberculosis patients in Texas, a large population-based analysis

BackgroundTuberculosis (TB) and diabetes mellitus (DM) comorbidity (TB-DM) is a major public health challenge worldwide. This analysis aimed to determine the risk factors and trends associated with TB-DM morbidity and mortality. MethodsRisk factors for TB-DM morbidity and mortality were identified by logistic regression using de-identified surveillance data of all TB patients from Texas, USA. reported between 01/2010–12/2016. Non-parametric testing was used for the morbidity and mortality trends. ResultsFrom 2010 to 2016, 1400/9002 (15.6%) TB patients were diabetic with an annual prevalence increase from 12.5% to 18.7% (p = 0.005). Reported TB-DM patients had a higher mortality (10.3%) than non-DM patients (7.6%, p = 0.001) with nearly a 3-fold increase in the odds of death (overall and during treatment). Older age, being Hispanic, chronic kidney failure, pulmonary cavitation and positive TB culture or smear were associated with TB-DM. Age ≥45, US-birth, resident of long-term care facility, injecting-drug user, chronic kidney disease, TB meningitis, abnormal chest radiograph, non-conversion of culture, and HIV(+) were independently associated with a higher mortality. ConclusionsTB-DM is an increasing public health problem in Texas with significantly high mortality. Risk factors for mortality determined by multivariate modeling will provide a foundation for the development of more effective strategies for TB-DM management.

Mortality in TB Patients with Inaccurate Drug Susceptibility Tests

The gold standard for treatment of tuberculosis (TB) is to guide therapy with culture-based phenotypic drug susceptibility test (DST) results. However,

HIV-related tuberculosis: mortality risk in persons without vs. with culture-confirmed disease.

Tuberculosis (TB) diagnosis in human immunodeficiency virus (HIV) positive persons is difficult, particularly in resource-limited settings. The relationship between TB culture status and mortality in HIV-positive persons treated for TB is unclear. We evaluated HIV-positive adults treated for TB at or after their first HIV clinic visit in Argentina, Brazil, Chile, Honduras, Mexico or Peru from 2000 to 2015. Anti-tuberculosis treatment included 2 months of isoniazid, rifampicin (RMP)/rifabutin (RBT), pyrazinamide ± ethambutol, followed by continuation phase treatment with isoniazid + RMP/RBT. Of 759 TB-HIV patients, 238 (31%) were culture-negative, 228 (30%) had unknown culture status or did not undergo culture and 293 (39%) were culture-positive. The median CD4 at TB diagnosis was 96 (interquartile range 40-228); 636 (84%) received concurrent antiretroviral therapy (ART) and anti-tuberculosis treatment. There were 123 (16%) deaths: 90/466 (19%) with TB culture-negative, unknown or not performed vs. 33/293 (11%) who were TB culture-positive (P = 0.005). In Kaplan-Meier analysis, mortality in TB patients without culture-confirmed disease was higher (P = 0.002). In a Cox model adjusted for age, sex, CD4, ART timing, disease site and stratified by study site, mortality in persons without culture-confirmed TB was not significantly increased compared to those with culture-positive TB (hazard ratio 1.39, 95%CI 0.89-2.16, P = 0.15). Most HIV-positive patients treated for TB did not have culture-confirmed TB, and mortality tended to be higher in patients without culture-confirmed disease, although the association was not statistically different after adjusting for other variables. Accurate TB diagnosis in HIV-positive persons is crucial.

Correction: Long-term outcome of smear-positive tuberculosis patients after initiation and completion of treatment: A ten-year retrospective cohort study.

[This corrects the article DOI: 10.1371/journal.pone.0193396.].

Factors Associated with Mortality in Tuberculosis Patients at Debre Birhan Referral Hospital, Ethiopia: A Retrospective Study

Background: Tuberculosis (TB) is the major cause of mortality worldwide and deaths from tuberculosis continue to occur despite the availability of effective antimicrobial agents. Understanding the factors associated with death is important to decrease mortality from TB. Hence, the aim of this study was to assess the magnitude and factors leading to death among TB patients registered at Debre Birhan Referral Hospital, Debre Birhan, Ethiopia.Methods: This is a retrospective cross-sectional study. Data was obtained by assessing medical records of 262 tuberculosis patients registered at Debre Birhan Referral Hospital from January 2013 to January 2015. Sociodemographic and clinical characteristics of the patients were collected from medical records using data extraction sheet. Chi-square analysis was used to determine the risk factors for TB mortality.Result: From a total of 262 registered TB patients included in the study, 249 were included in the analysis of which 41(16.5%) died during TB treatment. Of the patients with unsuccessful treatment outcome in this study, death was the most common advsserse TB treatment outcome. TB Mortality was significantly associated with the type of TB, HIV Co-infection, co-morbidity, sputum smear results and time to visit the hospital for diagnosis (p<0.05).Conclusion: The proportion of death among hospitalized TB patients was found to be high and several factors were associated with TB mortality. Hence, monitoring those factors is important to reduce the death rate in TB patients.

Effect of inpatient and outpatient care on treatment outcome in tuberculosis: a cohort study.

ABSTRACTObjectiveTo identify individual- and health services–related factors associated with deaths in subjects diagnosed with tuberculosis (TB).MethodsA nonconcurrent cohort study with passive follow-up was conducted using a probabilistic linkage method to analyze a sample of patients diagnosed and reported as having TB in 2006 and followed up until 2008. New cases, cases with previous treatment (readmission after loss to follow-up or relapse), and transfers across health services were included. Proportional hazards models were used to estimate the independent effect of covariates related to the individual and to the health services on mortality from all causes.ResultsAge above 60 years, admission to a hospital with emergency services, HIV-associated TB, and readmission to an outpatient facility after disease relapse or loss to follow-up were identified as risk factors for death. Variables related to process and results indicators of Brazil's National TB Program were not associated with mortality from all causes.ConclusionsAdvanced age, previous treatment for TB, and treatment at a secondary-level outpatient facility or a hospital with emergency services on site were associated with mortality in TB patients. Better strategies to improve TB care delivered at health units are needed to prevent death from TB, especially among the elderly.