Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia

Abstract

Setting: Five out-patient tuberculosis (TB) clinics and one in-patient TB hospital in Samara, Russia.

Objective: To identify predictors of all-cause mortality among patients with newly diagnosed TB.

Design: A retrospective case-control study of adult TB cases registered over a 5-year period from 1999 to 2003 using multivariate logistic regression modeling. Cases were defined as patients with TB who died within 12 months of diagnosis. Controls were patients with TB who survived at least 12 months.

Results: The case fatality rate was 3.6%. A total of 92 cases and 368 controls were identified. Mean age was 43 years; 71% were male; 4% were human immunodeficiency virus (HIV) seropositive. The median survival time for cases was 39.5 days. In multivariate analysis, independent predictors of mortality included bilateral lung involvement (OR 3.65), cavitary lesions on chest radiograph (CXR) (OR 2.45), symptoms >4 weeks at the time of diagnosis (OR 2.62), anemia (OR 5.24), and injection drug use (IDU) (OR 4.45), controlling for age.

Conclusion: Advanced TB disease at the time of diagnosis (as demonstrated by having bilateral lung involvement, cavitary disease, symptoms >1 month, and anemia) and IDU were associated with increased TB mortality in Samara. Interventions targeted at improving earlier TB case diagnosis and treatment may help to reduce mortality among patients with tuberculosis in this region.