Risk Factors Related with Mortality in Patient with Pulmonary Tuberculosis

Abstract

BackgroundThe prevalence rate of pulmonary tuberculosis (PTB) is steadily decreasing in South Korea. However, PTB is a disease with relatively high mortality and morbidity rates throughout Korea. Although there are many studies and statistics about the risk factors of PTB mortality in many countries, there are only a limited number of domestic papers on this topic. The aim of this study is to determine predictive factors for mortality among in-hospital patients associated with PTB.MethodsFrom December 2006 to January 2011, we reviewed medical records of 2,122 adult patients diagnosed with tuberculosis at a single tertiary hospital in a suburban area. In this study period, 960 patients were diagnosed with PTB by positive Acid fast bacilli smear and/or mycobacterial culture of the respiratory specimen. We compared the groups of patients deceased and patients discharged alive with PTB. The number of dead patients was 82 (47 males, 35 females).ResultsMortality was significantly associated with increased values of white blood cells (WBC), blood urine nitrogen (BUN), creatinine, C-reactive protein (CRP), numbers of involved lung field, and length of hospitalization. Also, it was associated with the decreased values of hemoglobin, lymphocyte, sodium, albumin, and cholesterol. Furthermore, admission through the emergency department, initial intensive care unit admission, and drug resistant PTB affected mortality in PTB patients. Independent predictors associated with PTB mortality are BUN, initial intensive care unit care, and admission during treatment of tuberculosis.ConclusionIn our study, mortality of pulmonary tuberculosis was related with parameters associated with nutritional status, disease severity at the time of admission, and drug resistance.

Risk Factors for Death during Pulmonary Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort Study

“…Previous studies included less than 300 patients (11, 21). In this study, independent risk factors for death were male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission.…”

“…However, the findings are inconsistent due to differences in the enrolled subjects, the burden of TB in the involved countries, human immunodeficiency virus (HIV) infection prevalence, and socioeconomic status (7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21). …”

Factors influencing development and mortality of acute respiratory failure in hospitalized patient with active pulmonary tuberculosis: a 10-year retrospective review

“…The aggressive immunologic responses to tuberculoprotein or a massive number of tubercle bacilli from reactivation of disease induces the hypersensitivity reaction and eventually develops into a systemic inflammatory response similar to a common systemic bacterial infection (27,28). The duration of illness usually is less than one month, which is different from common reactivation of disease (7,10,29,30). Dense consolidation with multiple anatomical lobes of lung infiltration on chest X-ray was seen in this pathophysiology (31).…”

“…In our study, short duration of illness, fever and dyspnea, and multiple-lobe infiltration on chest X-ray were among the significant independent risk factors of acute respiratory failure, which possibly indicated that these patients may suffer from severe acute tuberculous pneumonia. Several reports showed that acute tuberculous pneumonia and miliary tuberculosis are the significant causes of acute respiratory failure in pulmonary tuberculosis (10,30).…”

Factors associated with mortality among patients with active pulmonary tuberculosis requiring intensive care

“…(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) Identified risk factors for mortality include acute respiratory distress syndrome, (4,5) need for mechanical ventilation, (4) HIV infection, (7) multiple organ failure, (3,5) consolidation on chest radiograph, (3,5) acute renal failure, (4) early ICU admission, (13) Acute Physiology and Chronic Health Evaluation (APACHE) II score, (6) Sequential Organ Failure Assessment (SOFA) score, (14) sepsis, (4,6) low albumin, (7) age (15) and nosocomial-or ventilator-associated pneumonia. (4,8,13) Besides these factors, treating PTB in the ICU is challenging because of poor absorption of antituberculous treatment among the critically ill and the paradoxical deterioration of TB during treatment.…”