Treatment Outcomes of New Tuberculosis Patients Hospitalized in Kampala, Uganda: a Prospective Cohort Study

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2014 Mar 11

PMID 24608875

Citations 18

Authors

Bruce J Kirenga

Jonathan Levin

Irene Ayakaka

William Worodria

Nancy Reilly

Francis Mumbowa

Helen Nabanjja

Grace Nyakoojo

Kevin Fennelly

Susan Nakubulwa

Moses Joloba

Alphonse Okwera

Kathleen D Eisenach

Ruth McNerney

Alison M Elliott

Roy D Mugerwa

Peter G Smith

Jerrold J Ellner

Edward C Jones-Lopez

Affiliations

Soon will be listed here.

Abstract

Background: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda.

Methods And Findings: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045).

Conclusion: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART.

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References

Hansel N, Merriman B, Haponik E, Diette G . Hospitalizations for tuberculosis in the United States in 2000: predictors of in-hospital mortality. Chest. 2004; 126(4):1079-86. DOI: 10.1378/chest.126.4.1079. View

Corbett E, Marston B, Churchyard G, De Cock K . Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet. 2006; 367(9514):926-37. DOI: 10.1016/S0140-6736(06)68383-9. View

Olle-Goig J . Patients hospitalised in Bolivia with pulmonary tuberculosis: risk factors for dying. Int J Tuberc Lung Dis. 2002; 6(6):470-4. DOI: 10.5588/09640569512959. View

Vant Hoog A, Williamson J, Sewe M, Mboya P, Odeny L, Agaya J . Risk factors for excess mortality and death in adults with tuberculosis in Western Kenya. Int J Tuberc Lung Dis. 2012; 16(12):1649-56. DOI: 10.5588/ijtld.12.0135. View

Yen Y, Yen M, Shih H, Deng C . Risk factors for unfavorable outcome of pulmonary tuberculosis in adults in Taipei, Taiwan. Trans R Soc Trop Med Hyg. 2012; 106(5):303-8. DOI: 10.1016/j.trstmh.2012.01.011. View

Lopez-Gatell H, Cole S, Hessol N, French A, Greenblatt R, Landesman S . Effect of tuberculosis on the survival of women infected with human immunodeficiency virus. Am J Epidemiol. 2007; 165(10):1134-42. DOI: 10.1093/aje/kwk116. View

Shimazaki T, Marte S, Saludar N, Dimaano E, Salva E, Ariyoshi K . Risk factors for death among hospitalised tuberculosis patients in poor urban areas in Manila, The Philippines. Int J Tuberc Lung Dis. 2013; 17(11):1420-6. DOI: 10.5588/ijtld.12.0848. View

Palmieri F, Girardi E, Pellicelli A, Rianda A, Bordi E, Busi Rizzi E . Pulmonary tuberculosis in HIV-infected patients presenting with normal chest radiograph and negative sputum smear. Infection. 2002; 30(2):68-74. DOI: 10.1007/s15010-002-2062-9. View

Havlir D, Kendall M, Ive P, Kumwenda J, Swindells S, Qasba S . Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med. 2011; 365(16):1482-91. PMC: 3327101. DOI: 10.1056/NEJMoa1013607. View

10.

Greenaway C, Menzies D, Fanning A, Grewal R, Yuan L, FitzGerald J . Delay in diagnosis among hospitalized patients with active tuberculosis--predictors and outcomes. Am J Respir Crit Care Med. 2002; 165(7):927-33. DOI: 10.1164/ajrccm.165.7.2107040. View

11.

Whalen C, Nsubuga P, Okwera A, Johnson J, Hom D, Michael N . Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda. AIDS. 2000; 14(9):1219-28. PMC: 2869086. DOI: 10.1097/00002030-200006160-00020. View

12.

Volmink J, Garner P . Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2007; (4):CD003343. DOI: 10.1002/14651858.CD003343.pub3. View

13.

Greenland S . The need for reorientation toward cost-effective prediction: comments on 'Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond' by M. J. Pencina et al., Statistics in Medicine (DOI:.... Stat Med. 2007; 27(2):199-206. DOI: 10.1002/sim.2995. View

14.

Erhabor G, Adewole O, Ogunlade O . A five-year review of tuberculosis mortality amongst hospitalised patients in Ile-Ife. Indian J Chest Dis Allied Sci. 2006; 48(4):253-6. View

15.

Gandhi N, Shah N, Andrews J, Vella V, Moll A, Scott M . HIV coinfection in multidrug- and extensively drug-resistant tuberculosis results in high early mortality. Am J Respir Crit Care Med. 2009; 181(1):80-6. DOI: 10.1164/rccm.200907-0989OC. View

16.

Henegar C, Behets F, Vanden Driessche K, Tabala M, Bahati E, Bola V . Mortality among tuberculosis patients in the Democratic Republic of Congo. Int J Tuberc Lung Dis. 2012; 16(9):1199-204. DOI: 10.5588/ijtld.11.0613. View

17.

Abdool Karim S, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A . Integration of antiretroviral therapy with tuberculosis treatment. N Engl J Med. 2011; 365(16):1492-501. PMC: 3233684. DOI: 10.1056/NEJMoa1014181. View

18.

Taylor Z, Marks S, Rios Burrows N, Weis S, Stricof R, Miller B . Causes and costs of hospitalization of tuberculosis patients in the United States. Int J Tuberc Lung Dis. 2000; 4(10):931-9. PMC: 5448276. View

19.

Pablos-Mendez A, Sterling T, Frieden T . The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA. 1996; 276(15):1223-8. DOI: 10.1001/jama.1996.03540150025026. View

20.

Burton N, Forson A, Lurie M, Kudzawu S, Kwarteng E, Kwara A . Factors associated with mortality and default among patients with tuberculosis attending a teaching hospital clinic in Accra, Ghana. Trans R Soc Trop Med Hyg. 2011; 105(12):675-82. DOI: 10.1016/j.trstmh.2011.07.017. View