J Korean Med Sci.  2014 Sep;29(9):1226-1231. 10.3346/jkms.2014.29.9.1226.

Risk Factors for Death during Pulmonary Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort Study

• Kwon YS
• Kim YH
• Song JU
• Jeon K
• Song J
• Ryu YJ
• Choi JC
• Kim HC
• Koh WJ

• KMID: 1794600
• DOI: http://doi.org/10.3346/jkms.2014.29.9.1226

Abstract

The data regarding risk factors for death during tuberculosis (TB) treatment are inconsistent, and few studies examined this issue in Korea. The purpose of this study was to evaluate baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients who received TB treatment at eight hospitals from January 2009 to December 2010 was performed. Successful treatment included cure (1,129, 45.5%) and treatment completion (1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85, 3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariate analysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive care unit (ICU) admission were significant risk factors for death during TB treatment. Therefore, male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission could be baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea.

Keyword

Tuberculosis, Pulmonary; Therapeutics; Mortality, Korea

MeSH Terms

Adult
Aged
Anemia/complications
Antitubercular Agents/*therapeutic use
Cohort Studies
Dyspnea/complications
Female
Heart Diseases/complications
Humans
Intensive Care Units
Male
Middle Aged
Multivariate Analysis
Neoplasms/complications
Prognosis
Republic of Korea
Retrospective Studies
Risk Factors
Sex Factors
Treatment Outcome
Tuberculosis/complications/*drug therapy/mortality
Antitubercular Agents

Reference

1. World Health Organization. Global tuberculosis report 2013. Geneva: World Health Organization;2013. accessed on 1 March 2014. Available at http://www.who.int/tb/publications/global_report/en.

2. Korea Centers for Disease Control and Prevention. Annual report on the notified tuberculosis patients in Korea 2012. Cheongwon: Korea Centers for Disease Control and Prevention;2013. accessed on 1 March 2014. Available at http://tbfree.cdc.go.kr/tbfree/cmm/BoardList.do?boardType=REPORT&id=4500.

3. Park YK, Park YS, Na KI, Cho EH, Shin SS, Kim HJ. Increased tuberculosis burden due to demographic transition in Korea from 2001 to 2010. Tuberc Respir Dis. 2013; 74:104–110.

4. Park YS, Hong SJ, Boo YK, Hwang ES, Kim HJ, Cho SH, Na KI, Cho EH, Shin SS. The national status of tuberculosis using nationwide medical records survey of patients with tuberculosis in Korea. Tuberc Respir Dis. 2012; 73:48–55.

5. Kim HJ. Current status of tuberculosis in Korea. Korean J Med. 2012; 82:257–262.

6. Statistics Korea. Annual report of deaths by cause 2012. Daejeon: Statistics Korea;2013. accessed on 1 March 2014. Available at http://kosis.kr/ups/ups_01List01.jsp?grp_no=1005&pubcode=YD&type=F.

7. Mugusi FM, Mehta S, Villamor E, Urassa W, Saathoff E, Bosch RJ, Fawzi WW. Factors associated with mortality in HIV-infected and uninfected patients with pulmonary tuberculosis. BMC Public Health. 2009; 9:409.

8. Waitt CJ, Squire SB. A systematic review of risk factors for death in adults during and after tuberculosis treatment. Int J Tuberc Lung Dis. 2011; 15:871–885.

9. Baussano I, Pivetta E, Vizzini L, Abbona F, Bugiani M. Predicting tuberculosis treatment outcome in a low-incidence area. Int J Tuberc Lung Dis. 2008; 12:1441–1448.

10. Duarte EC, Bierrenbach AL, Barbosa da Silva J Jr, Tauil PL, de Fátima Duarte E. Factors associated with deaths among pulmonary tuberculosis patients: a case-control study with secondary data. J Epidemiol Community Health. 2009; 63:233–238.

11. Kim HJ, Lee CH, Shin S, Lee JH, Kim YW, Chung HS, Han SK, Shim YS, Kim DK. The impact of nutritional deficit on mortality of in-patients with pulmonary tuberculosis. Int J Tuberc Lung Dis. 2010; 14:79–85.

12. Lefebvre N, Falzon D. Risk factors for death among tuberculosis cases: analysis of European surveillance data. Eur Respir J. 2008; 31:1256–1260.

13. Low S, Ang LW, Cutter J, James L, Chee CB, Wang YT, Chew SK. Mortality among tuberculosis patients on treatment in Singapore. Int J Tuberc Lung Dis. 2009; 13:328–334.

14. Shen X, Deriemer K, Yuan Z, Shen M, Xia Z, Gui X, Wang L, Mei J. Deaths among tuberculosis cases in Shanghai, China: who is at risk? BMC Infect Dis. 2009; 9:95.

15. Vasankari T, Holmström P, Ollgren J, Liippo K, Kokki M, Ruutu P. Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study. BMC Public Health. 2007; 7:291.

16. Dewan PK, Arguin PM, Kiryanova H, Kondroshova NV, Khorosheva TM, Laserson K, Kluge H, Jakubowiak W, Wells C, Kazionny B. Risk factors for death during tuberculosis treatment in Orel, Russia. Int J Tuberc Lung Dis. 2004; 8:598–602.

17. Shimazaki T, Marte SD, Saludar NR, Dimaano EM, Salva EP, Ariyoshi K, Villarama JB, Suzuki M. Risk factors for death among hospitalised tuberculosis patients in poor urban areas in Manila, the Philippines. Int J Tuberc Lung Dis. 2013; 17:1420–1426.

18. Oursler KK, Moore RD, Bishai WR, Harrington SM, Pope DS, Chaisson RE. Survival of patients with pulmonary tuberculosis: clinical and molecular epidemiologic factors. Clin Infect Dis. 2002; 34:752–759.

19. Kourbatova EV, Borodulin BE, Borodulina EA, del Rio C, Blumberg HM, Leonard MK Jr. Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia. Int J Tuberc Lung Dis. 2006; 10:1224–1230.

20. Cullinan P, Meredith SK. Deaths in adults with notified pulmonary tuberculosis 1983-5. Thorax. 1991; 46:347–350.

21. Kim CW, Kim SH, Lee SN, Lee SJ, Lee MK, Lee JH, Shin KC, Yong SJ, Lee WY. Risk factors related with mortality in patient with pulmonary tuberculosis. Tuberc Respir Dis. 2012; 73:38–47.

22. Lee CH, Hwang JY, Oh DK, Kee MK, Oh E, An JW, Kim J, Do H, Kim HJ, Kim SS, et al. The burden and characteristics of tuberculosis/human immunodeficiency virus (TB/HIV) in South Korea: a study from a population database and a survey. BMC Infect Dis. 2010; 10:66.

23. Hwang JH, Choe PG, Kim NH, Bang JH, Song KH, Park WB, Kim ES, Park SW, Kim HB, Kim NJ, et al. Incidence and risk factors of tuberculosis in patients with human immunodeficiency virus infection. J Korean Med Sci. 2013; 28:374–377.

24. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. WHO/NMH/NHD/MNM/11.1. Geneva: World Health Organization;2011. accessed on 1 May 2014. Available at http://www.who.int/vmnis/indicators/haemoglobin.pdf.

25. Seung KJ, Bai GH, Kim SJ, Lew WJ, Park SK, Kim JY. The treatment of tuberculosis in South Korea. Int J Tuberc Lung Dis. 2003; 7:912–919.

26. Joint Committee for the Development of Korean Guidelines for Tuberculosis Korea Centers for Disease Control and Prevention. Korean Guidelines for Tuberculosis. 2011. accessed on 1 March 2014. Available at http://tbfree.cdc.go.kr/tbfree/guide.do?page=11&id=4110.

27. Kim HJ, Bai GH, Kang MK, Kim SJ, Lee JK, Cho SI, Lew WJ. A public-private collaboration model for treatment intervention to improve outcomes in patients with tuberculosis in the private sector. Tuberc Respir Dis. 2009; 66:349–357.

28. World Health Organization. Treatment of tuberculosis: guidelines for national programmes (4th Ed.) WHO/HTM/TB/2009.420. Geneva: World Health Organization;2009. accessed on 1 March 2014. Available at http://www.who.int/tb/publications/tb_treatmentguidelines/en.

29. Kim YH, Suh GY, Chung MP, Kim H, Kwon OJ, Lim SY, Lim SY, Koh WJ. Treatment of isoniazid-resistant pulmonary tuberculosis. BMC Infect Dis. 2008; 8:6.

30. Kwon YS, Kim YH, Suh GY, Chung MP, Kim H, Kwon OJ, Choi YS, Kim K, Kim J, Shim YM, et al. Treatment outcomes for HIV-uninfected patients with multidrug-resistant and extensively drug-resistant tuberculosis. Clin Infect Dis. 2008; 47:496–502.

31. Kwon YS, Chi SY, Oh IJ, Kim KS, Kim YI, Lim SC, Kim YC. Clinical characteristics and treatment outcomes of tuberculosis in the elderly: a case control study. BMC Infect Dis. 2013; 13:121.

32. Pérez-Guzmán C, Vargas MH, Torres-Cruz A, Villarreal-Velarde H. Does aging modify pulmonary tuberculosis? a meta-analytical review. Chest. 1999; 116:961–967.

33. Jeon DS, Shin DO, Park SK, Seo JE, Seo HS, Cho YS, Lee JY, Kim DY, Kong SJ, Kim YS, et al. Treatment outcome and mortality among patients with multidrug-resistant tuberculosis in tuberculosis hospitals of the public sector. J Korean Med Sci. 2011; 26:33–41.

34. Antoine D, French CE, Jones J, Watson JM. Tuberculosis treatment outcome monitoring in England, Wales and Northern Ireland for cases reported in 2001. J Epidemiol Community Health. 2007; 61:302–307.

35. Balasubramanian R, Garg R, Santha T, Gopi PG, Subramani R, Chandrasekaran V, Thomas A, Rajeswari R, Anandakrishnan S, Perumal M, et al. Gender disparities in tuberculosis: report from a rural DOTS programme in south India. Int J Tuberc Lung Dis. 2004; 8:323–332.

36. Moore RD. Human immunodeficiency virus infection, anemia, and survival. Clin Infect Dis. 1999; 29:44–49.

37. Ryu YJ, Koh WJ, Kang EH, Suh GY, Chung MP, Kim H, Kwon OJ. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology. 2007; 12:406–411.

38. Sharma SK, Mohan A, Banga A, Saha PK, Guntupalli KK. Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis. Int J Tuberc Lung Dis. 2006; 10:429–435.