High Mortality in Adults Hospitalized for Active Tuberculosis in a Low HIV Prevalence Setting

PLoS One. 2014 Mar 18;9(3):e92077. doi: 10.1371/journal.pone.0092077. eCollection 2014.

Abstract

Background: This study aims to evaluate the outcomes of adults hospitalized for tuberculosis in a higher-income region with low HIV prevalence.

Methods: A retrospective cohort study was conducted on all adults hospitalized for pulmonary and/or extrapulmonary tuberculosis in an acute-care hospital in Hong Kong during a two-year period. Microscopy and solid-medium culture were routinely performed. The diagnosis of tuberculosis was made by: (1) positive culture of M. tuberculosis, (2) positive M. tuberculosis PCR result, (3) histology findings of tuberculosis infection, and/or (4) typical clinico-radiological manifestations of tuberculosis which resolved after anti-TB treatment, in the absence of alternative diagnoses. Time to treatment ('early', started during initial admission; 'late', subsequent periods), reasons for delay, and short- and long-term survival were analyzed.

Results: Altogether 349 patients were studied [median(IQR) age 62(48-77) years; non-HIV immunocompromised conditions 36.7%; HIV/AIDS 2.0%]. 57.9%, 16.3%, and 25.8% had pulmonary, extrapulmonary, and pulmonary-extrapulmonary tuberculosis respectively. 58.2% was smear-negative; 0.6% multidrug-resistant. 43.4% developed hypoxemia. Crude 90-day and 1-year all-cause mortality was 13.8% and 24.1% respectively. 57.6% and 35.8% received 'early' and 'late' treatment respectively, latter mostly culture-guided [median(IQR) intervals, 5(3-9) vs. 43(25-61) days]. Diagnosis was unknown before death in 6.6%. Smear-negativity, malignancy, chronic lung diseases, and prior exposure to fluoroquinolones (adjusted-OR 10.6, 95%CI 1.3-85.2) delayed diagnosis of tuberculosis. Failure to receive 'early' treatment independently predicted higher mortality (Cox-model, adjusted-HR 1.8, 95%CI 1.1-3.0).

Conclusions: Mortality of hospitalized tuberculosis patients is high. Newer approaches incorporating methods for rapid diagnosis and initiation of anti-tuberculous treatment are urgently required to improve outcomes.

MeSH terms

  • Aged
  • Antitubercular Agents / therapeutic use
  • Coinfection
  • Delayed Diagnosis
  • Female
  • Fluoroquinolones / therapeutic use
  • HIV
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy
  • HIV Infections / mortality*
  • HIV Infections / virology
  • Hospital Mortality*
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / isolation & purification
  • Retrospective Studies
  • Survival Analysis
  • Tuberculosis, Central Nervous System / diagnosis
  • Tuberculosis, Central Nervous System / drug therapy
  • Tuberculosis, Central Nervous System / microbiology
  • Tuberculosis, Central Nervous System / mortality*
  • Tuberculosis, Lymph Node / diagnosis
  • Tuberculosis, Lymph Node / drug therapy
  • Tuberculosis, Lymph Node / microbiology
  • Tuberculosis, Lymph Node / mortality*
  • Tuberculosis, Multidrug-Resistant / diagnosis
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / microbiology
  • Tuberculosis, Multidrug-Resistant / mortality*
  • Tuberculosis, Pleural / diagnosis
  • Tuberculosis, Pleural / drug therapy
  • Tuberculosis, Pleural / microbiology
  • Tuberculosis, Pleural / mortality*
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / microbiology
  • Tuberculosis, Pulmonary / mortality*
  • Tuberculosis, Urogenital / diagnosis
  • Tuberculosis, Urogenital / drug therapy
  • Tuberculosis, Urogenital / microbiology
  • Tuberculosis, Urogenital / mortality*

Substances

  • Antitubercular Agents
  • Fluoroquinolones

Grant support

The authors have no support or funding to report.