Long-term mortality in patients with pulmonary and extrapulmonary tuberculosis: a Danish nationwide cohort study

Abstract

BackgroundLong-term mortality and causes of death in patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) are poorly documented. In this study, long-term mortality and causes of death in PTB and EPTB patients were compared with the background population and it was investigated whether mortality was associated with family-related risk factors.MethodsA nationwide cohort study was conducted including: all adult Danes notified with PTB or EPTB from 1977 to 2008 and alive 1 year after diagnosis; a randomly selected comparison cohort matched on birth date and sex; adult siblings of PTB patients; and population controls. Data were extracted from national registries. All-cause and cause-specific mortality rate ratios were calculated for patients and siblings and compared with their respective control cohorts. A total of 8,291 patients (6,402 PTB and 1,889 EPTB), 24,873 population controls, 1,990 siblings of PTB patients and 11,679 siblings of PTB population controls were included.ResultsOverall, the mortality rate ratio was 1.86 (95% confidence interval [CI] 1.77–1.96) for PTB patients and 1.24 (95% CI 1.12–1.37) for EPTB patients. Both patient cohorts had significantly increased risk of death due to infectious diseases and diabetes. Further, the PTB patients had increased mortality due to cancers (mainly respiratory and gastrointestinal tract), liver and respiratory system diseases, and alcohol and drug abuse. The PTB patients had increased mortality compared with their siblings (mortality rate ratio 3.55; 95% CI 2.57–4.91) as did the siblings of the PTB patients compared with the siblings of population controls (mortality rate ratio 2.16; 95% CI 1.62–2.87).ConclusionWe conclude that adult PTB patients have an almost two-fold increased long-term mortality whereas EPTB patients have a slightly increased long-term mortality compared with the background population. The increased long-term mortality in PTB patients stems from diseases associated with alcohol, tobacco, and drug abuse as well as immune suppression, and family-related factors.

Prognostic score to predict mortality during TB treatment in TB/HIV co-infected patients

“…It is possible that patients with TB-CXR and positive cultures may have a higher Mtb bacillary load and more disseminated lesions, which may increase the risk for death. A similar result has been described by Christensen et al in their study in which pulmonary TB patients had an almost two-fold increased long-term mortality than extrapulmonary TB patients [ 25 ]. Although both TB-CXR and cavitation on CXR were evaluated in the initial multivariate model, only TB-CXR was significant.…”

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

“…In contrary to this, younger patients had higher mortality in Chenai, India [ 17 ]. Clinical factors like smear-positivity, poor treatment outcome, multidrug-resistant TB (MDR-TB), late treatment start, history of previous treatment and comorbidity increased the risk of TB death [ 15 , 17 , 21 – 23 ]. Other studies also reported that poor nutrition and behavioral factors like smoking, alcoholism and drug abuse increased the risk of death due to TB [ 17 , 21 , 23 ].…”

Development and validation of a prognostic score to predict tuberculosis mortality

“…Christensen et al described a similar result where pulmonary TB patients have an almost two-fold increased long-term mortality than extrapulmonary TB patients. 25 With poor living conditions, it is also obvious that patients who were homeless or reported being residents of a long-term care facility had a high rate of mortality. Different than Jung and coworkers' study that reported a higher mortality rate in the foreign-born TB patients in the whole U.S., 26 our data showed a higher mortality rate in U.S.-born TB patients in Texas.…”