Table 2.
Comparison of adult patients with tuberculosis-related deaths who died during treatment and control patients who completed treatment
| Characteristic | Patients Who Died during Treatment (N = 705) | Control Subjects (N = 1,039) | P Value |
|---|---|---|---|
| Demographic | |||
| Age, yr, mean, median (IQR) | 64.9, 66.1 (51.9–79.9) | 62.5, 66.9 (50.6–76.4) | 0.01 |
| Male | 481 (68) | 666 (64) | 0.08 |
| White non-Hispanic | 290 (41) | 413 (40) | 0.6 |
| Black non-Hispanic | 250 (35) | 249 (24) | <0.001 |
| Asian | 153 (22) | 370 (36) | <0.001 |
| Hispanic | 160 (23) | 206 (20) | 0.2 |
| U.S. born | 378 (54) | 399 (38) | <0.001 |
| Socioeconomic/behavioral | |||
| Unemployed | 542 (77) | 633 (61) | <0.001 |
| Homeless | 64 (9) | 56 (5) | 0.003 |
| Incarcerated | 17 (2) | 33 (3) | 0.3 |
| Injection drug use | 34 (5) | 20 (2) | <0.001 |
| Noninjection drug use | 75 (11) | 60 (6) | <0.001 |
| Excess alcohol | 126 (18) | 110 (11) | <0.001 |
| Long-term care facility | 110 (16) | 43 (4) | <0.001 |
| Clinical | |||
| Pulmonary TB only | 440 (62) | 801 (77) | <0.001 |
| Extrapulmonary TB only | 74 (11) | 156 (15) | 0.006 |
| Both extrapulmonary and pulmonary TB | 191 (27) | 82 (8) | <0.001 |
| Bilateral disease | 328 (47) | 269 (26) | <0.001 |
| Cavities on chest image | 180 (26) | 254 (24) | 0.6 |
| Effusion | 272 (39) | 183 (18) | <0.001 |
| Hemorrhage | 7 (1) | 4 (0.4) | 0.1 |
| Meningeal TB | 75 (11) | 10 (1) | <0.001 |
| Gastrointestinal TB | 28 (4) | 14 (1) | <0.001 |
| Peritoneal TB | 26 (4) | 16 (1.5) | 0.004 |
| Miliary TB | 48 (7) | 4 (0.4) | <0.001 |
| Pneumothorax | 25 (4) | 2 (0.2) | <0.001 |
| Extensive pulmonary destruction | 252 (36) | 216 (21) | <0.001 |
| Respiratory failure | 352 (50) | 27 (3) | <0.001 |
| Smear positive* | 423 (60) | 423 (41) | <0.001 |
| Multidrug-resistant TB | 13 (2) | 0 | <0.001 |
| History of TB | 56 (8) | 71 (7) | 0.4 |
| HIV status | <0.001 | ||
| HIV negative | 283 (40) | 758 (73) | |
| HIV positive | 141 (20) | 47 (5) | |
| HIV test not offered | 98 (14) | 57 (5) | |
| HIV test refused | 24 (3) | 57 (5) | |
| Unknown HIV test result | 159 (23) | 120 (12) | |
| Coronary artery disease | 143 (20) | 109 (10) | <0.001 |
| Cancer | 66 (9) | 44 (4) | <0.001 |
| COPD | 184 (26) | 130 (13) | <0.001 |
| Condition affecting the liver† | 215 (31) | 166 (16) | <0.001 |
| Cirrhosis | 70 (10) | 20 (2) | <0.001 |
| Hepatitis (viral) | 90 (13) | 65 (6) | <0.001 |
| Diabetes mellitus | 183 (26) | 235 (23) | 0.1 |
| Renal failure | 24 (3) | 6 (0.6) | <0.001 |
| Immunosuppressive medications‡ | 40 (6) | 18 (2) | <0.001 |
| Cognitive impairment | 198 (28) | 53 (5) | <0.001 |
| Physical inability to self-medicate | 108 (15) | 27 (3) | <0.001 |
| No reported TB symptom | 48 (7) | 161 (15) | <0.001 |
| Reported cough§ | 421 (64) | 653 (75) | <0.001 |
| Reported fever§ | 358 (55) | 383 (44) | <0.001 |
| Reported weight loss§ | 424 (65) | 491 (56) | <0.001 |
| Reported night sweats§ | 178 (27) | 289 (33) | 0.01 |
| Reported shortness of breath§ | 348 (49) | 304 (29) | <0.001 |
| Reported loss of appetite§ | 285 (40) | 256 (25) | <0.001 |
| Reported chest pain§ | 128 (18) | 173 (17) | 0.4 |
| Reported hemoptysis§ | 73 (11) | 144 (16) | 0.003 |
| Health care | |||
| Competing diagnosis|| | 304 (43) | 280 (27) | <0.001 |
| TST not done | 341 (48) | 332 (32) | <0.001 |
| Incomplete evaluation¶ | 126 (18) | 110 (11) | <0.001 |
| Treatment characteristics | |||
| Initiated on RIPE | 610 (87) | 933 (90) | 0.04 |
| PZA was excluded from initial treatment regimen | 59 (8) | 37 (4) | <0.001 |
| DOT was initiated | 232 (33) | 874 (84) | <0.001** |
| DOT missing data | 414 (59) | 46 (4) | |
| Treatment interruptions | 92 (13) | 210 (20) | <0.001 |
| SAE from TB meds** | 76 (11) | 102 (10) | 0.5 |
| TB treatment discontinued due to SAE of TB meds | 64 (9) | 73 (7) | 0.1 |
| Drug interactions†† | 19 (3) | 12 (1) | 0.02 |
| Patient refused treatment at any time during treatment course | 42 (6) | 29 (3) | 0.001 |
| Health department activities‡‡ | |||
| Lost to follow-up ≥30 d | 10 (1.4) | 14 (1.3) | 0.9 |
Definition of abbreviations: AFB = acid-fast bacilli; COPD = chronic obstructive pulmonary disease; DOT = directly observed therapy; HIV = human immunodeficiency virus; IQR = interquartile range; PZA = pyrazinamide; RIPE = rifampin, isoniazid, pyrazinamide and ethambutol; SAE = severe adverse events; TB = tuberculosis; TST = tuberculin skin test.
Data presented as n (%) unless otherwise noted.
Smear-positive indicates positive on AFB smear microscopy. Comparison group was negative or unknown results on AFB smear microscopy.
Patient had cirrhosis or viral hepatitis or reported using excess alcohol.
Includes prednisone, tumor necrosis factor-α inhibitors.
Denominators are for patients who reported any TB symptom—patients who died during treatment = 657; control patients who completed treatment = 878.
A diagnosis other than TB was made before TB diagnosis.
Patient pulmonary evaluation did not include collection of three consecutive sputum samples for AFB smear microscopy within 4 days of hospitalization, or within 30 days if the patient with pulmonary disease was diagnosed as an outpatient. For patients with extrapulmonary TB only, no imaging or laboratory tests were documented.
SAEs documented to be possible due to TB treatment include hepatitis, hepatic failure, seizures, anaphylaxis, thrombocytopenia, severe dermatitis, cardiac event.
Drug interactions between TB medications and other medications that patient was taking were documented.
Of patients who died during treatment, 339 (48%) died within 30 days. Patients who died within 30 days had limited opportunity to have a tracking interview or home visit within 30 days.