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Open Access Highly Accessed Research article

Tuberculosis mortality: patient characteristics and causes

Chou-Han Lin1, Chou-Jui Lin2, Yao-Wen Kuo3, Jann-Yuan Wang3, Chia-Lin Hsu3, Jong-Min Chen3, Wern-Cherng Cheng4 and Li-Na Lee4*

Author Affiliations

1 Department of Internal Medicine, Far Eastern Memorial Hospital: No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, Taiwan

2 Department of Internal Medicine, Tao-Yuan General Hospital, No.1492, Chung-Shan Road, Taoyuan City, Taoyuan County, Taiwan

3 Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, Taiwan

4 Department of Laboratory Medicine, National Taiwan University College of Medicine and Hospital, No.7, Chung-Shan South Road, Taipei 10002, Taiwan

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BMC Infectious Diseases 2014, 14:5  doi:10.1186/1471-2334-14-5

Published: 3 January 2014

Abstract

Background

In the antibiotic era, tuberculosis (TB) still causes a substantial number of mortalities. We aimed to identify the causes and risks of death among TB patients.

Methods

Medical records of mortality cases of culture-proven TB diagnosed during 2003–2007 were reviewed. All TB deaths were classified into 2 groups (TB-related and non-TB-related), based on the underlying cause of death.

Results

During the study period, 2016 cases (male: 71.1%) of culture-proven TB were identified. The mean age was 59.3 (range: 0.3–96) years. The overall mortality rate was 12.3% (249 cases) and the mean age at death was 74 years; 17.3% (43 cases) of all TB deaths were TB-related. Most of the TB-related deaths occurred early (median survival: 20 days), and the patient died of septic shock. Malignancy, liver cirrhosis, renal failure, and miliary and pneumonic radiographic patterns were all independent predictors for all TB deaths. Cavitary, miliary and pneumonic radiographic patterns were all significant predictive factors for TB-related death. Extrapulmonary involvement and liver cirrhosis were also factors contributing to TB-related death.

Conclusions

The majority of TB deaths were ascribed to non-TB-related causes. Managing TB as well as underlying comorbidities in a multidisciplinary approach is essential to improve the outcome of patients in an aging population. However, the clinical manifestations of patients with TB-related death vary; many progressed to fulminant septic shock requiring timely recognition with prompt treatment to prevent early death.

Keywords:
Tuberculosis; Mortality; Risk factor