Risk factors associated with mortality rates among tuberculosis patients at Banglamung Hospital during fiscal years 2016-2018

Abstract

Tuberculosis (TB) is one of the top 10 causes of death in both the world and Thailand. An unacceptable high mortality rate was as high as 10% among tuberculosis (TB) cases in Banglamung District, Chin Buri Province. The aim of this study was to identify risk factors associated with death in TB patients registered at Banglamung Hospital. It is a retrospective, unmatched, case-control study. The samples included new or recurrent cases of tuberculosis who had been registered for treatment during Fiscal Years 2016-2018. The study arm consists of 127 fatal TB cases, who had died of severity of the disease, treatment-related complications, bacterial infections or comorbidity. The control arm is comprised of 254 non-fatal TB patients with treatment success. A multiple logistic regression analysis was performed to compute odd ratio with 95% confidence interval (CI) (significance level at 0.05). Based on multivariate analysis, it was found that risk factors associated with case mortality during treatment were age >65 years old (OR 3.32, p 0.007), having developed symptoms >30 days prior to treatment initiation (OR 5.30, p<0.001), disseminated tuberculosis (OR 3.34, p 0.018), presenting with dyspnea (OR 5.53, p<0.001), HIV infection (OR 2.57, p 0.005), and hypoalbuminemia (OR 4.75, p<0.001). To reduce death rates, we therefore recommend close monitoring and initiation of proper management in those who are the elderly, TB patients co-infected with HIV, with presence of disseminated tuberculosis, presenting with dyspnea, and hypoalbuminemia, in parallel with public education about abnormal symptoms that warrant medical attention in order to reduce the delay of diagnosis and treatment, and deaths from tuberculosis.