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Risk factors related with mortality in patient with pulmonary tuberculosis.

Kim CW, Kim SH, Lee SN, Lee SJ, Lee MK, Lee JH, Shin KC, Yong SJ, Lee WY - Tuberc Respir Dis (Seoul) (2012)

Bottom Line: We compared the groups of patients deceased and patients discharged alive with PTB.Mortality 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT

Background: The 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.

Methods: From 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).

Results: Mortality 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.

Conclusion: In our study, mortality of pulmonary tuberculosis was related with parameters associated with nutritional status, disease severity at the time of admission, and drug resistance.

No MeSH data available.


Related in: MedlinePlus

Age distribution of decedents.
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Figure 2: Age distribution of decedents.

Mentions: In the study conducted in North Carolina, US, Nguyen et al.9 reported 721 (13.5%) death cases out of 5,311 TB patients over the period of 10 years (1993~2003). According to the study, risk factors of TB death included old age, miliary or meningeal diseases and human immunodeficiency virus (HIV). In the study conducted in San Francisco, California, US, Nahid et al.10, reported 37 (6.6%) death cases out of 565 patients between 1990 and 2001, and factors of death such as HIV infection, old age, positive sputum exam result, and poor TB treatments. According to the study by Low et al.11 conducted in 7,433 patients in Singapore between 2000 and 2006, 884 (11.9%) patients died. Risk factors included old age, male, Malayan, microbiological definite diagnosis, history of using long-term care facilities, and strains having resistance against at least isoniazid. Lefebvre and Falzon12 reported 3,085 (7.8%) cases of death out of 39,566 patients in 15 EU countries between 2002 and 2004. Risk factors of death included old age and resistance against isoniazid and rifampin in addition to male and history of TB treatments. In Africa, more studies on HIV have been reported than studies on risk factors associated with TB13,14. Few studies have been reported on risk factors of TB death in Korea. Shin et al.15 reported 27 death cases with 54 control group patients in 2006. In the study, significant difference was confirmed in comorbidity, admission via emergency room, initial ICU treatments, dyspnea at admission, general weakness, miliary TB, hemoglobin, blood urea nitrogen, albumin, cholesterol, AST and CRP. Among these, initial ICU treatments and albumin were confirmed as independent factors. In the areas other than Africa, old age, HIV, gender and isoniazid drug-resistant strains were risk factors. Since age and gender were analyzed in pair in Korean studies including the present study, age and gender were excluded from risk factors. But, number of death patients showed an increase in elderly patients in the age of 60 or older (Figure 2) evidencing an old age as a factor associated with death. Presence of drug-resistant strains had a statistical significance between two groups, but when drug-resistant strains were compared according to each agent, no significant finding was observed. Due to small numbers of drug-resistant strains, it was not easy to confirm significance. Tests on HIV were not conducted and accordingly, its possibility as a risk factor was not confirmed. However, considering increasing number of HIV patients, studies on HIV will be necessary as Shin et al.15 suggested.


Risk factors related with mortality in patient with pulmonary tuberculosis.

Kim CW, Kim SH, Lee SN, Lee SJ, Lee MK, Lee JH, Shin KC, Yong SJ, Lee WY - Tuberc Respir Dis (Seoul) (2012)

Age distribution of decedents.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3475478&req=5

Figure 2: Age distribution of decedents.
Mentions: In the study conducted in North Carolina, US, Nguyen et al.9 reported 721 (13.5%) death cases out of 5,311 TB patients over the period of 10 years (1993~2003). According to the study, risk factors of TB death included old age, miliary or meningeal diseases and human immunodeficiency virus (HIV). In the study conducted in San Francisco, California, US, Nahid et al.10, reported 37 (6.6%) death cases out of 565 patients between 1990 and 2001, and factors of death such as HIV infection, old age, positive sputum exam result, and poor TB treatments. According to the study by Low et al.11 conducted in 7,433 patients in Singapore between 2000 and 2006, 884 (11.9%) patients died. Risk factors included old age, male, Malayan, microbiological definite diagnosis, history of using long-term care facilities, and strains having resistance against at least isoniazid. Lefebvre and Falzon12 reported 3,085 (7.8%) cases of death out of 39,566 patients in 15 EU countries between 2002 and 2004. Risk factors of death included old age and resistance against isoniazid and rifampin in addition to male and history of TB treatments. In Africa, more studies on HIV have been reported than studies on risk factors associated with TB13,14. Few studies have been reported on risk factors of TB death in Korea. Shin et al.15 reported 27 death cases with 54 control group patients in 2006. In the study, significant difference was confirmed in comorbidity, admission via emergency room, initial ICU treatments, dyspnea at admission, general weakness, miliary TB, hemoglobin, blood urea nitrogen, albumin, cholesterol, AST and CRP. Among these, initial ICU treatments and albumin were confirmed as independent factors. In the areas other than Africa, old age, HIV, gender and isoniazid drug-resistant strains were risk factors. Since age and gender were analyzed in pair in Korean studies including the present study, age and gender were excluded from risk factors. But, number of death patients showed an increase in elderly patients in the age of 60 or older (Figure 2) evidencing an old age as a factor associated with death. Presence of drug-resistant strains had a statistical significance between two groups, but when drug-resistant strains were compared according to each agent, no significant finding was observed. Due to small numbers of drug-resistant strains, it was not easy to confirm significance. Tests on HIV were not conducted and accordingly, its possibility as a risk factor was not confirmed. However, considering increasing number of HIV patients, studies on HIV will be necessary as Shin et al.15 suggested.

Bottom Line: We compared the groups of patients deceased and patients discharged alive with PTB.Mortality 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

ABSTRACT

Background: The 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.

Methods: From 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).

Results: Mortality 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.

Conclusion: In our study, mortality of pulmonary tuberculosis was related with parameters associated with nutritional status, disease severity at the time of admission, and drug resistance.

No MeSH data available.


Related in: MedlinePlus