Independent predictors of tuberculosis mortality in a high HIV prevalence setting: a retrospective cohort study
Author(s)
Pepper, DJ
Schomaker, M
Wilkinson, RJ
de Azevedo, V
Maartens, G
Type
Journal Article
Abstract
Background
Identifying those at increased risk of death during TB treatment is a priority in resource-constrained settings. We performed this study to determine predictors of mortality during TB treatment.
Methods
We performed a retrospective analysis of a TB surveillance population in a high HIV prevalence area that was recorded in ETR.net (Electronic Tuberculosis Register). Adult TB cases initiated TB treatment from 2007 through 2009 in Khayelitsha, South Africa. Cox proportional hazards models were used to identify risk factors for death (after multiple imputations for missing data). Model selection was performed using Akaike’s Information Criterion to obtain the most relevant predictors of death.
Results
Of 16,209 adult TB cases, 851 (5.3 %) died during TB treatment. In all TB cases, advancing age, co-infection with HIV, a prior history of TB and the presence of both pulmonary and extra-pulmonary TB were independently associated with an increasing hazard of death. In HIV-infected TB cases, advancing age and female gender were independently associated with an increasing hazard of death. Increasing CD4 counts and antiretroviral treatment during TB treatment were protective against death. In HIV-uninfected TB cases, advancing age was independently associated with death, whereas smear-positive disease was protective.
Conclusion
We identified several independent predictors of death during TB treatment in resource-constrained settings. Our findings inform resource-constrained settings about certain subgroups of TB patients that should be targeted to improve mortality during TB treatment.
Identifying those at increased risk of death during TB treatment is a priority in resource-constrained settings. We performed this study to determine predictors of mortality during TB treatment.
Methods
We performed a retrospective analysis of a TB surveillance population in a high HIV prevalence area that was recorded in ETR.net (Electronic Tuberculosis Register). Adult TB cases initiated TB treatment from 2007 through 2009 in Khayelitsha, South Africa. Cox proportional hazards models were used to identify risk factors for death (after multiple imputations for missing data). Model selection was performed using Akaike’s Information Criterion to obtain the most relevant predictors of death.
Results
Of 16,209 adult TB cases, 851 (5.3 %) died during TB treatment. In all TB cases, advancing age, co-infection with HIV, a prior history of TB and the presence of both pulmonary and extra-pulmonary TB were independently associated with an increasing hazard of death. In HIV-infected TB cases, advancing age and female gender were independently associated with an increasing hazard of death. Increasing CD4 counts and antiretroviral treatment during TB treatment were protective against death. In HIV-uninfected TB cases, advancing age was independently associated with death, whereas smear-positive disease was protective.
Conclusion
We identified several independent predictors of death during TB treatment in resource-constrained settings. Our findings inform resource-constrained settings about certain subgroups of TB patients that should be targeted to improve mortality during TB treatment.
Date Issued
2015-10-06
Date Acceptance
2015-09-25
Citation
AIDS Research and Therapy, 2015, 12
ISSN
1742-6405
Publisher
BioMed Central
Journal / Book Title
AIDS Research and Therapy
Volume
12
Copyright Statement
© 2015 Pepper et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.
License URL
Sponsor
Wellcome Trust
Grant Number
104803/Z/14/ZR
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Tuberculosis
HIV
Mortality
Predictors
Multivariate analysis
HUMAN-IMMUNODEFICIENCY-VIRUS
RURAL SOUTH-AFRICA
PULMONARY TUBERCULOSIS
RISK-FACTORS
FOLLOW-UP
CLINICAL DETERIORATION
TREATMENT OUTCOMES
REDUCES MORTALITY
DRUG-RESISTANCE
EARLY DEATH
Virology
1107 Immunology
Publication Status
Published
Article Number
35