Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment

PLoS One. 2016 Aug 3;11(8):e0159925. doi: 10.1371/journal.pone.0159925. eCollection 2016.

Abstract

Objective: To determine the case-fatality rate (CFR) at the end of the intensive phase of tuberculosis (TB) treatment, and factors associated with fatality.

Methods: TB patients diagnosed between 2006 and 2013 were followed-up during treatment. We computed the CFR at the end of the intensive phase of TB treatment, and the incidence of death per 100 person-days (pd) of follow-up. We performed survival analysis using the Kaplan-Meier method and Cox regression, and calculate hazard ratios (HR) and 95% confidence intervals (CI).

Results: A total of 5,182 patients were included, of whom 180 (3.5%) died; 87 of these deaths (48.3%) occurred during the intensive phase of treatment, with a CFR of 1.7%. The incidence of death was 0.028/100 pd. The following factors were associated with death during the intensive phase: being >50 years (HR = 36.9;CI:4.8-283.4); being retired (HR = 2.4;CI:1.1-5.1); having visited the emergency department (HR = 3.1;CI:1.2-7.7); HIV infection (HR = 3.4;CI:1.6-7.2); initial standard treatment with 3 drugs (HR = 2.0;CI:1.2-3.3) or non-standard treatments (HR = 2.68;CI:1.36-5.25); comprehension difficulties (HR = 2.8;CI:1.3-6.1); and smear-positive sputum (HR = 2.3-CI:1.0-4.8).

Conclusion: There is a non-negligible CFR during the intensive phase of TB, whose reduction should be prioritised. The CFR could be a useful indicator for evaluating TB programs.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use*
  • Coinfection
  • Female
  • HIV Infections / complications
  • HIV Infections / mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors
  • Survival Analysis
  • Tuberculosis / complications
  • Tuberculosis / drug therapy*
  • Tuberculosis / mortality
  • Young Adult

Substances

  • Antitubercular Agents

Grants and funding

This study was funded by SEPAR that is the Spanish Society of Pneumology ("Sociedad Española de Pneumología y Cirugía Torácica") Grant Number: 207/2011 (URL: http://www.separ.es). Authors TR, JAC, JMG-G, MAJ-F, JFM, JPM, JR-M and JC are affiliated to, but do not receive a salary from SEPAR. JAC is also affiliated to, but does not receive a salary from the International Union Against Tuberculosis and Lung Disease. SEPAR and the International Union Against Tuberculosis and Lung Disease did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.