Predictors of death during tuberculosis treatment, Phrae province, Thailand
DOI:
https://doi.org/10.14456/dcj.2014.19Keywords:
mortality density rate, median follow up time, redictors of death, TB type, co-morbiditiesAbstract
Tuberculosis remains a major health problem in Thailand because the patients' mortality rate still high although the effective treatment program has developed. This retrospective cohort study was designed aiming to identify predictive factors of death during tuberculosis treatment and to explore the mortality rate of tuberculosis in Phrae province, Thailand. All patients diagnosed as TB and registred at Phrae hospital since October 2009- September 2011 were reviewed. All patients were followed since the time of diagnosis until the end of treatment. Univariable and Multivariable Cox's Regression were performed to identify possible predictors of death during treatment. There were 469 patients, reviewed; and 66 of them died during treat¬ment (14.0796) or mortality density rate 6.86 per 10,000 persons-days. The median follow up time among survival group was 192 days (ranging from 24 to 365 days) while that in mortality group was 49 days (from 1 to 365 days). Predictors of death were duration of symptoms shorter than 30 days (HR = 2.06, p = 0.046), comorbidities: ischemic heart disease (HR = 3.80, p = 0.006), cerebrovascular disease (HR = 3.57, p = 0.017), malignancy (HR = 5.59, p = 0.001), sepsis (HR = 5.24, p = 0.029), gastro¬intestinal side effects from anti-TB drugs (HR = 3.33, p = 0.001), smear negative pulmonary TB (HR = 2.67, p = 0.008) and extra-pulmonary TB (HR 2.31, p = 0.042). The results of this study suggested that the early close monitoring system after initiating TB treatment is imperative. The early case detection, diagnostic guideline for diagnosis of smear negative pulmonary TB and CO-morbidities control should be strengthened.
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