The mean duration of hospitalization was 16.8 ± 24.5 days (range, 1 to 251 days). Resistance to any one of the first-line antituberculous agents was present in 24 patients (11.8%), while multidrug resistance was identified in only 3 patients (1.5%). All patients who were treated received at least two drugs to which the mycobacterial isolate was sensitive. Twenty-six patients (12.8%) never received adequate drug therapy during the study period due to either a lack of compliance (n = 15) or the severity of other comor-bid conditions that limited the administration of such therapy (n = 11). All 11 patients in this latter group died during the follow-up period.
Of the 203 patients included, 57 (28.1%) died during the 14-month period following hospitalization. Of this group, 17 (29.8%) died during the initial hospitalization; the remainder died following hospital discharge. Canadianneighborpharmacy.com Click Here Of the 26 patients with respiratory failure, 16 (61.5%) died during the follow-up period and of these, 7 (43.8%) died during the initial hospitalization. Univariate analysis identified demographic characteristics and risk factors for tuberculosis that were significantly associated with mortality, as shown in Table 1. Most significant among these were advanced age, residence in an extended-care facility, malnutrition, a history of silicosis, and end-stage renal disease. Among the characteristics of disease presentation and treatment, respiratory failure, dyspnea, weakness, and miliary disease were most closely associated with death (Table 2). Coinfection with HIV, sputum smear positivity, and cavitary disease were not significantly associated with mortality. Although incomplete, based on the available data, we found no association between the results of the tuberculin skin test and mortality (p = 0.175). Similarly, neither a 24-h nor a 7-day delay in the initiation of antituberculous chemotherapy was statistically associated with a fatal outcome.
Multiple logistic regression analysis, controlling for gender, age, race, and potential risk factors for mortality identified by univariate analysis, demonstrated that respiratory failure requiring mechanical ventilation and end-stage renal disease requiring dialysis had the greatest impact on survival (Table 4). Malnutrition, age > 60 years, drug-associated immunosuppression, and dyspnea at the time of hospital presentation were also found to be significantly related to the likelihood of dying during the follow-up period (Table 4).
Table 4—Multivariate Logistic Regression Model for Mortality Among Patients Hospitalized for Tuberculosis
|F actor||Adjusted Odds Ratio||95% Cl||p Value|
|Respiratory failure||6.5||6.0-7.0||< 0.001|
|Age > 60 yr||3.5||2.4-5.2||< 0.001|
|End-stage renal disease||7.0||3.7-13.3||0.002|