title: Clinical characteristics and evolution of non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis.
abstract: OBJECTIVE
  To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis.
  
  
  METHODS
  This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated.
  
  
  RESULTS
  During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids.
  
  
  CONCLUSIONS
  The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients.
authors.affiliation: Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. denise.rossato@terra.com.br
authors.forename: Denise Rossato
authors.initials: DR
authors.lastname: Silva
authors.forename: Diego Millán
authors.initials: DM
authors.lastname: Menegotto
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Schulz
authors.forename: Marcelo Basso
authors.initials: MB
authors.lastname: Gazzana
authors.forename: Paulo de Tarso Roth
authors.initials: Pde T
authors.lastname: Dalcin
mesh_terms: D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis*; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014376:Tuberculosis / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality*