Mortality in a large tuberculosis treatment trial: modifiable and non-modifiable risk factors.

Sterling TR, Zhao Z, Khan A, Chaisson RE, Schluger N, Mangura B, Weiner M, Vernon A, Tuberculosis Trials Consortium
Int J Tuberc Lung Dis. 2006 10 (5): 542-9

PMID: 16704037

SETTING - North America.

OBJECTIVES - Tuberculosis (TB) patients in North America often have characteristics that may increase overall mortality. Identifying modifiable risk factors would allow for improvements in outcome.

DESIGN - We evaluated mortality in a large TB treatment trial conducted in the United States and Canada. Persons with culture-positive pulmonary TB were enrolled after 2 months of treatment, treated for 4 more months under direct observation, and followed for 2 years (total observation: 28 months). Cause of death was determined by death certificate, autopsy, and/or clinical observation.

RESULTS - Of 1075 participants, 71 (6.6%) died: 15/71 (21.1%) HIV-infected persons, and 56/1004 (5.6%) non-HIV-infected persons (P < 0.001). Only one death was attributed to TB. Cox multivariate regression analysis identified four independent risk factors for death after controlling for age: malignancy (hazard ratio [HR] 5.28, P < 0.0001), HIV (HR 3.89, P < 0.0001), daily alcohol (HR 2.94, P < 0.0001), and being unemployed (HR 1.99, P = 0.01). The risk of death increased with the number of independent risk factors present (P < 0.0001). Extent of disease and treatment failure/relapse were not associated with an increased risk of death.

CONCLUSIONS - Death due to TB was rare. Interventions to treat malignancy, HIV, and alcohol use in TB patients are needed to reduce mortality in this patient population.

MeSH Terms (17)

Adult Americas Antitubercular Agents Canada Cause of Death Chi-Square Distribution Directly Observed Therapy Drug Therapy, Combination Female Humans Male Multicenter Studies as Topic Proportional Hazards Models Randomized Controlled Trials as Topic Risk Factors Treatment Outcome Tuberculosis, Pulmonary

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