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

Factors Associated with Fatality during the Intensive Phase of Anti-Tuberculosis Treatment.
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Rodrigo T, Casals M, Caminero JA, García-García JM, Jiménez-Fuentes MA, Medina JF, Millet JP, Ruiz-Manzano J, Caylá J, ,


Rodrigo T, Casals M, Caminero JA, García-García JM, Jiménez-Fuentes MA, Medina JF, Millet JP, Ruiz-Manzano J, Caylá J, , (click to view)

Rodrigo T, Casals M, Caminero JA, García-García JM, Jiménez-Fuentes MA, Medina JF, Millet JP, Ruiz-Manzano J, Caylá J, ,

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PloS one 2016 08 0311(8) e0159925 doi 10.1371/journal.pone.0159925

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.

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