Abstract
SETTING: North America. OBJECTIVES: Tuberculosis (TB) patients in North America often have characteristics that may increase overall mortality. Identifying modifiable risk factors would allow for improvements in outcome. DESIGN: We evaluated mortality in a large TB treatment trial conducted in the United States and Canada. Persons with culture-positive pulmonary TB were enrolled after 2 months of treatment, treated for 4 more months under direct observation, and followed for 2 years (total observation: 28 months). Cause of death was determined by death certificate, autopsy, and/or clinical observation. RESULTS: Of 1075 participants, 71 (6.6%) died: 15/71 (21.1%) HIV-infected persons, and 56/1004 (5.6%) non-HIV-infected persons (P < 0.001). Only one death was attributed to TB. Cox multivariate regression analysis identified four independent risk factors for death after controlling for age: malignancy (hazard ratio [HR] 5.28, P < 0.0001), HIV (HR 3.89, P < 0.0001), daily alcohol (HR 2.94, P < 0.0001), and being unemployed (HR 1.99, P = 0.01). The risk of death increased with the number of independent risk factors present (P < 0.0001). Extent of disease and treatment failure/relapse were not associated with an increased risk of death. CONCLUSIONS: Death due to TB was rare. Interventions to treat malignancy, HIV, and alcohol use in TB patients are needed to reduce mortality in this patient population.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 542-549 |
| Number of pages | 8 |
| Journal | International Journal of Tuberculosis and Lung Disease |
| Volume | 10 |
| Issue number | 5 |
| State | Published - May 2006 |
| Externally published | Yes |
Fingerprint
Keywords
- HIV
- Malignancy
- Mortality
- Tuberculosis
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
Mortality in a large tuberculosis treatment trial : Modifiable and non-modifiable risk factors. / Sterling, Timothy R.; Zhao, Z.; Khan, A.; Chaisson, R. E.; Schluger, N.; Mangura, B.; Weiner, Marc H; Vernon, A.
In: International Journal of Tuberculosis and Lung Disease, Vol. 10, No. 5, 05.2006, p. 542-549.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Mortality in a large tuberculosis treatment trial
T2 - Modifiable and non-modifiable risk factors
AU - Sterling, Timothy R.
AU - Zhao, Z.
AU - Khan, A.
AU - Chaisson, R. E.
AU - Schluger, N.
AU - Mangura, B.
AU - Weiner, Marc H
AU - Vernon, A.
PY - 2006/5
Y1 - 2006/5
N2 - SETTING: North America. OBJECTIVES: Tuberculosis (TB) patients in North America often have characteristics that may increase overall mortality. Identifying modifiable risk factors would allow for improvements in outcome. DESIGN: We evaluated mortality in a large TB treatment trial conducted in the United States and Canada. Persons with culture-positive pulmonary TB were enrolled after 2 months of treatment, treated for 4 more months under direct observation, and followed for 2 years (total observation: 28 months). Cause of death was determined by death certificate, autopsy, and/or clinical observation. RESULTS: Of 1075 participants, 71 (6.6%) died: 15/71 (21.1%) HIV-infected persons, and 56/1004 (5.6%) non-HIV-infected persons (P < 0.001). Only one death was attributed to TB. Cox multivariate regression analysis identified four independent risk factors for death after controlling for age: malignancy (hazard ratio [HR] 5.28, P < 0.0001), HIV (HR 3.89, P < 0.0001), daily alcohol (HR 2.94, P < 0.0001), and being unemployed (HR 1.99, P = 0.01). The risk of death increased with the number of independent risk factors present (P < 0.0001). Extent of disease and treatment failure/relapse were not associated with an increased risk of death. CONCLUSIONS: Death due to TB was rare. Interventions to treat malignancy, HIV, and alcohol use in TB patients are needed to reduce mortality in this patient population.
AB - SETTING: North America. OBJECTIVES: Tuberculosis (TB) patients in North America often have characteristics that may increase overall mortality. Identifying modifiable risk factors would allow for improvements in outcome. DESIGN: We evaluated mortality in a large TB treatment trial conducted in the United States and Canada. Persons with culture-positive pulmonary TB were enrolled after 2 months of treatment, treated for 4 more months under direct observation, and followed for 2 years (total observation: 28 months). Cause of death was determined by death certificate, autopsy, and/or clinical observation. RESULTS: Of 1075 participants, 71 (6.6%) died: 15/71 (21.1%) HIV-infected persons, and 56/1004 (5.6%) non-HIV-infected persons (P < 0.001). Only one death was attributed to TB. Cox multivariate regression analysis identified four independent risk factors for death after controlling for age: malignancy (hazard ratio [HR] 5.28, P < 0.0001), HIV (HR 3.89, P < 0.0001), daily alcohol (HR 2.94, P < 0.0001), and being unemployed (HR 1.99, P = 0.01). The risk of death increased with the number of independent risk factors present (P < 0.0001). Extent of disease and treatment failure/relapse were not associated with an increased risk of death. CONCLUSIONS: Death due to TB was rare. Interventions to treat malignancy, HIV, and alcohol use in TB patients are needed to reduce mortality in this patient population.
KW - HIV
KW - Malignancy
KW - Mortality
KW - Tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=33646342793&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33646342793&partnerID=8YFLogxK
M3 - Article
C2 - 16704037
AN - SCOPUS:33646342793
VL - 10
SP - 542
EP - 549
JO - International Journal of Tuberculosis and Lung Disease
JF - International Journal of Tuberculosis and Lung Disease
SN - 1027-3719
IS - 5
ER -