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Risk factors for mortality among patients with extrapulmonary tuberculosis at an academic inner-city hospital in the US

  • Infectious Diseases
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Abstract

Despite an overall decrease in numbers of tuberculosis (TB) cases in the US, the proportion of extrapulmonary TB cases has increased. The study objective was to determine the most important predictors of all-cause mortality among patients with extrapulmonary TB. A retrospective chart review of adult extrapulmonary TB cases registered between 01/1995 and 12/2001 at Grady Memorial Hospital (a 1,000 bed, public inner-city hospital in Atlanta) was performed. Risk factors for death within 12 months after diagnosis of extrapulmonary TB were identified in multivariate analysis using log-binomial regression model. A total of 212 cases of extrapulmonary TB were identified; 100 (47%) were HIV-infected. The majority of patients were male (68%) and African-American (84%); mean age was 40 years. The most common sites of extrapulmonary TB were: lymph node (26%), pleural (21%), disseminated (20%), and central nervous system (CNS) or meningeal (16%). All-cause mortality rate in patients with extrapulmonary TB was 15% (21% among HIV-seropositive and 9% among HIV-uninfected patients, p = 0.02). In multivariate analysis, independent predictors of mortality included disseminated disease (PR = 4.66, 95% CI 1.93–11.24) and CNS/meningeal extrapulmonary TB (PR = 4.29, 95% CI 1.78–10.33), controlling for HIV infection. Extrapulmonary TB continues to be a persistent problem in the inner city and is associated with high mortality rates, especially among HIV-infected. Disseminated disease and the presence of CNS/meningeal TB are associated with poor prognosis.

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Abbreviations

AIDS:

acquired immunodeficiency syndrom

CI:

confidence interval

CNS:

central nervous system

DOT:

directly observed therapy

ELISA:

Enzyme-Linked Immunoabsorbent Assay

GMH:

Grady Memorial Hospital

HAART:

highly active antiretroviral therapy

HIV:

human immunodeficiency virus

MDR:

multidrug-resistant

PCP:

Pneumocystis carinii pneumonia

PR:

prevalence ratio

TB:

tuberculosis

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Acknowledgements

Financial support. Georgia Department of Human Resources (GA DHR) (427-93-71898) and GA DHR (427-93-36021) (MKL), and the National Institutes of Health [NIH] (NHLBI [K07 HL03078] and Fogarty International Center [FIC] [D43 TW007124 and D43 TW01042]) (HMB, CDR).

Conflict of interest. There was no conflict of interest for all authors.

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Authors and Affiliations

  1. Division of Infectious Diseases, Emory University School of Medicine, 69 Jesse Hill Jr Drive, Atlanta, GA, 30303, USA

    Ekaterina V. Kourbatova, Michael K. Leonard Jr, Javier Romero, Colleen Kraft, Carlos del Rio & Henry M. Blumberg

  2. Grady Memorial Hospital, Atlanta, GA, USA

    Michael K. Leonard Jr, Carlos del Rio & Henry M. Blumberg

Authors
  1. Ekaterina V. Kourbatova
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  2. Michael K. Leonard Jr
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  3. Javier Romero
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  4. Colleen Kraft
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  5. Carlos del Rio
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  6. Henry M. Blumberg
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Correspondence to Michael K. Leonard Jr.

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Kourbatova, E., Leonard, M., Romero, J. et al. Risk factors for mortality among patients with extrapulmonary tuberculosis at an academic inner-city hospital in the US. Eur J Epidemiol 21, 715–721 (2006). https://doi.org/10.1007/s10654-006-9060-7

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  • DOI: https://doi.org/10.1007/s10654-006-9060-7

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