title: Treatment options and outcomes of hospitalised tuberculosis patients: a nationwide study.
abstract: METHODS
  Although standardised multidrug treatments exist, mortality among hospitalised tuberculosis (TB) patients is high.
  
  
  OBJECTIVE
  To characterise TB patients requiring acute hospital care and identify factors associated with in-hospital mortality.
  
  
  METHODS
  Using a Japanese national database of acute-care hospitals, we identified patients with sputum smear-positive pulmonary TB who were discharged (both deceased and alive) between July 2010 and March 2013. Demographic characteristics, comorbidity, procedures and treatments were examined. We performed a multivariable logistic regression analysis to identify risk factors for in-hospital mortality.
  
  
  RESULTS
  Of 877 treated patients (566 males, mean age 74.5 years) identified, 152 (17.3%) died. A standard four-drug regimen of isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide was given to 279 (31.8%) patients, and INH, RMP and EMB to 335 (38.2%) patients. Multivariable analysis showed that the three-drug regimen was significantly associated with higher rates of in-hospital mortality (OR 1.87, 95%CI 1.07-3.27, P = 0.028). Other factors associated with in-hospital death were age, male sex, smoking habit, emergency admission, dementia and severe respiratory condition.
  
  
  CONCLUSIONS
  The risk factors for in-hospital death identified include the use of the three-drug regimen. Treatment choice could influence the outcome of hospitalised TB patients.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Bunkyo City Public Health Center, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamana
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007538:Isoniazid / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011718:Pyrazinamide / Q000627:therapeutic use; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin