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title:A Study of the Timing of Death in Patients with Tuberculosis Who Die During Anti-Tuberculosis Treatment

Author:Bhavik Patel, Prashant Gohil, J.N.Patel, Kshitij Mandke, Sonalba Solanki

Keywords:Tuberculosis, India, Death, Timing of death

Type:Original Article

Abstract:Introduction: India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TB related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India: - i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with “early” death, occurring in the initial 8 weeks of treatment. Methodology: This was a retrospective study in C.U.Shah Medical College & Hospital in Surendranagar, Gujarat India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2007 to April 2012. Results: There were 376 TB patients of whom 41 (11%) were known to have died during treatment. Case-fatality was higher in those previously treated (24%) and lower in those with extra-pulmonary TB (1%).Most of deaths during anti-tuberculosis treatment were early, with 66% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with “early death”. In this large cohort of TB patients, Most of deaths occurred early after starting anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/ AIDS and diabetes mellitus, which are known to influence mortality. iii) Late stage presentation by patients themselves. More research in this area from prospective and retrospective studies is needed.

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