Initial presentations predict mortality in pulmonary tuberculosis patients--a prospective observational study

Despite effective anti-TB treatments, tuberculosis remains a serious threat to public health and is associated with high mortality. Old age and multiple co-morbidities are known risk factors for death. The association of clinical presentations with mortality in pulmonary tuberculosis patients remain...

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Published in:PloS one 2011-09, Vol.6 (9), p.e23715-e23715
Main Authors: Feng, Jia-Yih, Su, Wei-Juin, Chiu, Yu-Chi, Huang, Shiang-Fen, Lin, Yung-Yang, Huang, Ruay-Ming, Lin, Ching-Hsiung, Hwang, Jhi-Jhu, Lee, Jen-Jyh, Yu, Ming-Chih, Yu, Kwok-Woon, Lee, Yu-Chin
Format: Article
Language:English
Subjects:
Aged
Analysis
Anorexia
Clinical medicine
Cough
Demographics
Disease
Drug resistance
Dyspnea
Early experience
Epidemiology
Ethics
Female
Fever
Genotype
Genotype & phenotype
Health care facilities
Health risks
HIV
Hospitals
Human immunodeficiency virus
Humans
Infections
Intensive care
Internal medicine
Kidneys
Male
Malignancy
Medical centers
Medical diagnosis
Medical laboratories
Medical research
Medicine
Middle Aged
Mortality
Mycobacterium - genetics
Mycobacterium tuberculosis
Observational studies
Patient outcomes
Patients
Prognosis
Prospective Studies
Public health
Pulmonary tuberculosis
Renal insufficiency
Respiration
Review boards
Risk analysis
Risk factors
Studies
Survival Rate
Tuberculosis
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - microbiology
Tuberculosis, Pulmonary - mortality
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cited_by cdi_FETCH-LOGICAL-c757t-64bcf663714a40cee2f0596c90dcd16c55f87be17607e0754cdb0efe2f7d7b203
cites cdi_FETCH-LOGICAL-c757t-64bcf663714a40cee2f0596c90dcd16c55f87be17607e0754cdb0efe2f7d7b203
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container_title PloS one
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creator Feng, Jia-Yih
Su, Wei-Juin
Chiu, Yu-Chi
Huang, Shiang-Fen
Lin, Yung-Yang
Huang, Ruay-Ming
Lin, Ching-Hsiung
Hwang, Jhi-Jhu
Lee, Jen-Jyh
Yu, Ming-Chih
Yu, Kwok-Woon
Lee, Yu-Chin
description Despite effective anti-TB treatments, tuberculosis remains a serious threat to public health and is associated with high mortality. Old age and multiple co-morbidities are known risk factors for death. The association of clinical presentations with mortality in pulmonary tuberculosis patients remains an issue of controversy. This prospective observational study enrolled newly diagnosed, culture-proven pulmonary tuberculosis patients from five medical centers and one regional hospital, which were referral hospitals of TB patients. Radiographic findings and clinical symptoms were determined at the time of diagnosis. Patients who died for any reason during the course of anti-TB treatment were defined as mortality cases and death that occurred within 30 days of initiating treatment was defined as early mortality. Clinical factors associated with overall mortality and early mortality were investigated. A total of 992 patients were enrolled and 195 (19.7%) died. Nearly one-third (62/195, 31.8%) of the deaths occurred before or within 30 days of treatment initiation. Older age (RR = 1.04, 95%CI: 1.03-1.05), malignancy (RR = 2.42, 95%CI: 1.77-3.31), renal insufficiency (RR = 1.77, 95%CI: 1.12-2.80), presence of chronic cough (RR = 0.63, 95%CI: 0.47-0.84), fever (RR = 1.45, 95%CI: 1.09-1.94), and anorexia (RR = 1.49, 95%CI: 1.07-2.06) were independently associated with overall mortality. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients present with fever (p
doi_str_mv 10.1371/journal.pone.0023715
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Old age and multiple co-morbidities are known risk factors for death. The association of clinical presentations with mortality in pulmonary tuberculosis patients remains an issue of controversy. This prospective observational study enrolled newly diagnosed, culture-proven pulmonary tuberculosis patients from five medical centers and one regional hospital, which were referral hospitals of TB patients. Radiographic findings and clinical symptoms were determined at the time of diagnosis. Patients who died for any reason during the course of anti-TB treatment were defined as mortality cases and death that occurred within 30 days of initiating treatment was defined as early mortality. Clinical factors associated with overall mortality and early mortality were investigated. A total of 992 patients were enrolled and 195 (19.7%) died. Nearly one-third (62/195, 31.8%) of the deaths occurred before or within 30 days of treatment initiation. Older age (RR = 1.04, 95%CI: 1.03-1.05), malignancy (RR = 2.42, 95%CI: 1.77-3.31), renal insufficiency (RR = 1.77, 95%CI: 1.12-2.80), presence of chronic cough (RR = 0.63, 95%CI: 0.47-0.84), fever (RR = 1.45, 95%CI: 1.09-1.94), and anorexia (RR = 1.49, 95%CI: 1.07-2.06) were independently associated with overall mortality. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients present with fever (p&lt;0.001), anorexia (p = 0.005), and without chronic cough (p&lt;0.001). Among patients of mortality, those with respiratory symptoms of chronic cough (RR = 0.56, 95%CI: 0.33-0.98) and dyspnea (HR = 0.51, 95%CI: 0.27-0.98) were less likely to experience early mortality. The radiological features were comparable between survivors and non-survivors. In addition to demographic characteristics, clinical presentations including the presence of fever, anorexia, and the absence of chronic cough, were also independent predictors for on-treatment mortality in pulmonary tuberculosis patients.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0023715</identifier><identifier>PMID: 21931610</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Analysis ; Anorexia ; Clinical medicine ; Cough ; Demographics ; Disease ; Drug resistance ; Dyspnea ; Early experience ; Epidemiology ; Ethics ; Female ; Fever ; Genotype ; Genotype &amp; phenotype ; Health care facilities ; Health risks ; HIV ; Hospitals ; Human immunodeficiency virus ; Humans ; Infections ; Intensive care ; Internal medicine ; Kidneys ; Male ; Malignancy ; Medical centers ; Medical diagnosis ; Medical laboratories ; Medical research ; Medicine ; Middle Aged ; Mortality ; Mycobacterium - genetics ; Mycobacterium tuberculosis ; Observational studies ; Patient outcomes ; Patients ; Prognosis ; Prospective Studies ; Public health ; Pulmonary tuberculosis ; Renal insufficiency ; Respiration ; Review boards ; Risk analysis ; Risk factors ; Studies ; Survival Rate ; Tuberculosis ; Tuberculosis, Pulmonary - diagnosis ; Tuberculosis, Pulmonary - microbiology ; Tuberculosis, Pulmonary - mortality</subject><ispartof>PloS one, 2011-09, Vol.6 (9), p.e23715-e23715</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Feng et al. 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Adithya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Initial presentations predict mortality in pulmonary tuberculosis patients--a prospective observational study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2011-09-13</date><risdate>2011</risdate><volume>6</volume><issue>9</issue><spage>e23715</spage><epage>e23715</epage><pages>e23715-e23715</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Despite effective anti-TB treatments, tuberculosis remains a serious threat to public health and is associated with high mortality. Old age and multiple co-morbidities are known risk factors for death. The association of clinical presentations with mortality in pulmonary tuberculosis patients remains an issue of controversy. This prospective observational study enrolled newly diagnosed, culture-proven pulmonary tuberculosis patients from five medical centers and one regional hospital, which were referral hospitals of TB patients. Radiographic findings and clinical symptoms were determined at the time of diagnosis. Patients who died for any reason during the course of anti-TB treatment were defined as mortality cases and death that occurred within 30 days of initiating treatment was defined as early mortality. Clinical factors associated with overall mortality and early mortality were investigated. A total of 992 patients were enrolled and 195 (19.7%) died. Nearly one-third (62/195, 31.8%) of the deaths occurred before or within 30 days of treatment initiation. Older age (RR = 1.04, 95%CI: 1.03-1.05), malignancy (RR = 2.42, 95%CI: 1.77-3.31), renal insufficiency (RR = 1.77, 95%CI: 1.12-2.80), presence of chronic cough (RR = 0.63, 95%CI: 0.47-0.84), fever (RR = 1.45, 95%CI: 1.09-1.94), and anorexia (RR = 1.49, 95%CI: 1.07-2.06) were independently associated with overall mortality. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients present with fever (p&lt;0.001), anorexia (p = 0.005), and without chronic cough (p&lt;0.001). Among patients of mortality, those with respiratory symptoms of chronic cough (RR = 0.56, 95%CI: 0.33-0.98) and dyspnea (HR = 0.51, 95%CI: 0.27-0.98) were less likely to experience early mortality. The radiological features were comparable between survivors and non-survivors. In addition to demographic characteristics, clinical presentations including the presence of fever, anorexia, and the absence of chronic cough, were also independent predictors for on-treatment mortality in pulmonary tuberculosis patients.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21931610</pmid><doi>10.1371/journal.pone.0023715</doi><tpages>e23715</tpages><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
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1932-6203
language eng
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source PubMed (Medline); Publicly Available Content Database
subjects Aged
Analysis
Anorexia
Clinical medicine
Cough
Demographics
Disease
Drug resistance
Dyspnea
Early experience
Epidemiology
Ethics
Female
Fever
Genotype
Genotype & phenotype
Health care facilities
Health risks
HIV
Hospitals
Human immunodeficiency virus
Humans
Infections
Intensive care
Internal medicine
Kidneys
Male
Malignancy
Medical centers
Medical diagnosis
Medical laboratories
Medical research
Medicine
Middle Aged
Mortality
Mycobacterium - genetics
Mycobacterium tuberculosis
Observational studies
Patient outcomes
Patients
Prognosis
Prospective Studies
Public health
Pulmonary tuberculosis
Renal insufficiency
Respiration
Review boards
Risk analysis
Risk factors
Studies
Survival Rate
Tuberculosis
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - microbiology
Tuberculosis, Pulmonary - mortality
title Initial presentations predict mortality in pulmonary tuberculosis patients--a prospective observational study
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