title: Factors associated with mortality in patients with drug-susceptible pulmonary tuberculosis.
abstract: BACKGROUND
  Tuberculosis is a leading cause of death worldwide, yet the determinants of death are not well understood. We sought to determine risk factors for mortality during treatment of drug-susceptible pulmonary tuberculosis under program settings.
  
  
  METHODS
  Retrospective chart review of patients with drug-susceptible tuberculosis reported to the San Francisco Tuberculosis Control Program from 1990-2001.
  
  
  RESULTS
  Of 565 patients meeting eligibility criteria, 37 (6.6%) died during the study period. Of 37 deaths, 12 (32.4%) had tuberculosis listed as a contributing factor. In multivariate analysis controlling for follow-up time, four characteristics were independently associated with mortality: HIV co-infection (HR = 2.57, p = 0.02), older age at tuberculosis diagnosis (HR = 1.52 per 10 years, p = 0.001); initial sputum smear positive for acid fast bacilli (HR = 3.07, p = 0.004); and experiencing an interruption in tuberculosis therapy (HR = 3.15, p = 0.002). The association between treatment interruption and risk of death was due to non-adherence during the intensive phase of treatment (HR = 3.20, p = 0.001). The median duration of treatment interruption did not differ significantly in either intensive or continuation phases between those who died and survived (23 versus 18 days, and 37 versus 29 days, respectively). No deaths were directly attributed to adverse drug reactions.
  
  
  CONCLUSIONS
  In addition to advanced age, HIV and characteristics of advanced tuberculosis, experiencing an interruption in anti-tuberculosis therapy, primarily due to non-adherence, was also independently associated with increased risk of death. Improving adherence early during treatment for tuberculosis may both improve tuberculosis outcomes as well as decrease mortality.
authors.affiliation: Curry International Tuberculosis Center, University of California, San Francisco, CA, USA. pnahid@ucsf.edu
authors.forename: Payam
authors.initials: P
authors.lastname: Nahid
authors.forename: Leah G
authors.initials: LG
authors.lastname: Jarlsberg
authors.forename: Irina
authors.initials: I
authors.lastname: Rudoy
authors.forename: Bouke C
authors.initials: BC
authors.lastname: de Jong
authors.forename: Alon
authors.initials: A
authors.lastname: Unger
authors.forename: L Masae
authors.initials: LM
authors.lastname: Kawamura
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Osmond
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hopewell
authors.forename: Charles L
authors.initials: CL
authors.lastname: Daley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D012495:San Francisco; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality* / Q000523:psychology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents