Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission

Abstract

Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions:Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment.

Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study

“…But neither of these studies has assessed post-discharge mortality. In a retrospective cohort study, Silva et al ( 15 ) evaluated new cases of TB treated in the emergency room of a university hospital and that required hospitalization. They included 305 patients with TB and described an in-hospital mortality of 16.4% and one-year mortality of 31.8%.…”

“…Some of these hospitalizations relate to cases that are more severe ( 13 , 14 ). A retrospective cohort study of patients hospitalized for TB in Southern Brazil identified a one-year mortality of 31.8% in post-discharge subjects ( 15 ). Determining outcomes and the factors associated with them following discharge from TB hospitalization is crucial to better understand the potential impact of the disease, which may help establish health policies to improve survival.…”

Predictors of In-Hospital Mortality among Patients with Pulmonary Tuberculosis: A Systematic Review and Meta-analysis

“…TB does not usually require hospital admission for treatment, but if symptoms such as shortness of breath, and deterioration in a systemic condition are present, hospitalization may be necessary. A large proportion of patients with TB are hospitalized 8 , 9 , and estimates of in-hospital mortality range from 2% to 12% 10 – 14 ; most of the current costs of TB treatment result from hospitalization 15 .…”