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Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis

BACKGROUND: Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings. METHODS: Retrospective chart review of patients...

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Autores principales: Nahid, Payam, Jarlsberg, Leah G, Rudoy, Irina, de Jong, Bouke C, Unger, Alon, Kawamura, L Masae, Osmond, Dennis H, Hopewell, Philip C, Daley, Charles L
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022714/
https://www.ncbi.nlm.nih.gov/pubmed/21199579
http://dx.doi.org/10.1186/1471-2334-11-1
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author Nahid, Payam
Jarlsberg, Leah G
Rudoy, Irina
de Jong, Bouke C
Unger, Alon
Kawamura, L Masae
Osmond, Dennis H
Hopewell, Philip C
Daley, Charles L
author_facet Nahid, Payam
Jarlsberg, Leah G
Rudoy, Irina
de Jong, Bouke C
Unger, Alon
Kawamura, L Masae
Osmond, Dennis H
Hopewell, Philip C
Daley, Charles L
author_sort Nahid, Payam
collection PubMed
description BACKGROUND: Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings. METHODS: Retrospective chart review of patients with drug-susceptible tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001. RESULTS: Of 565 patients meeting eligibility criteria, 37 (6.6%) died during the study period. Of 37 deaths, 12 (32.4%) had tuberculosis listed as a contributing factor. In multivariate analysis controlling for follow-up time, four characteristics were independently associated with mortality: HIV co-infection (HR = 2.57, p = 0.02), older age at tuberculosis diagnosis (HR = 1.52 per 10 years, p = 0.001); initial sputum smear positive for acid fast bacilli (HR = 3.07, p = 0.004); and experiencing an interruption in tuberculosis therapy (HR = 3.15, p = 0.002). The association between treatment interruption and risk of death was due to non-adherence during the intensive phase of treatment (HR = 3.20, p = 0.001). The median duration of treatment interruption did not differ significantly in either intensive or continuation phases between those who died and survived (23 versus 18 days, and 37 versus 29 days, respectively). No deaths were directly attributed to adverse drug reactions. CONCLUSIONS: In addition to advanced age, HIV and characteristics of advanced tuberculosis, experiencing an interruption in anti-tuberculosis therapy, primarily due to non-adherence, was also independently associated with increased risk of death. Improving adherence early during treatment for tuberculosis may both improve tuberculosis outcomes as well as decrease mortality.
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spelling pubmed-30227142011-01-19 Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis Nahid, Payam Jarlsberg, Leah G Rudoy, Irina de Jong, Bouke C Unger, Alon Kawamura, L Masae Osmond, Dennis H Hopewell, Philip C Daley, Charles L BMC Infect Dis Research Article BACKGROUND: Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings. METHODS: Retrospective chart review of patients with drug-susceptible tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001. RESULTS: Of 565 patients meeting eligibility criteria, 37 (6.6%) died during the study period. Of 37 deaths, 12 (32.4%) had tuberculosis listed as a contributing factor. In multivariate analysis controlling for follow-up time, four characteristics were independently associated with mortality: HIV co-infection (HR = 2.57, p = 0.02), older age at tuberculosis diagnosis (HR = 1.52 per 10 years, p = 0.001); initial sputum smear positive for acid fast bacilli (HR = 3.07, p = 0.004); and experiencing an interruption in tuberculosis therapy (HR = 3.15, p = 0.002). The association between treatment interruption and risk of death was due to non-adherence during the intensive phase of treatment (HR = 3.20, p = 0.001). The median duration of treatment interruption did not differ significantly in either intensive or continuation phases between those who died and survived (23 versus 18 days, and 37 versus 29 days, respectively). No deaths were directly attributed to adverse drug reactions. CONCLUSIONS: In addition to advanced age, HIV and characteristics of advanced tuberculosis, experiencing an interruption in anti-tuberculosis therapy, primarily due to non-adherence, was also independently associated with increased risk of death. Improving adherence early during treatment for tuberculosis may both improve tuberculosis outcomes as well as decrease mortality. BioMed Central 2011-01-03 /pmc/articles/PMC3022714/ /pubmed/21199579 http://dx.doi.org/10.1186/1471-2334-11-1 Text en Copyright ©2011 Nahid et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Nahid, Payam
Jarlsberg, Leah G
Rudoy, Irina
de Jong, Bouke C
Unger, Alon
Kawamura, L Masae
Osmond, Dennis H
Hopewell, Philip C
Daley, Charles L
Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
title Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
title_full Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
title_fullStr Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
title_full_unstemmed Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
title_short Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
title_sort factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022714/
https://www.ncbi.nlm.nih.gov/pubmed/21199579
http://dx.doi.org/10.1186/1471-2334-11-1
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