Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study.

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.

Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.

Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis.

SETTING: One of the most serious problems in tuberculosis (TB) control is non-adherence to treatment. Several strategies have been developed to improve adherence and increase the cure rate. OBJECTIVE: To systematically review interventions to improve adherence to anti-tuberculosis treatment. DESIGN: We performed a systematic review and meta-analysis of 22 randomised clinical trials (RCTs) to ascertain whether providing directly observed treatment, short-course (DOTS), financial incentives, food incentives and/or patient education/counselling improved adherence to anti-tuberculosis treatment. The primary outcome was cure rate; secondary outcomes were default and mortality rates. Sources used were Medline (accessed via PubMed), Cochrane Central, LILACS (Literatura Latino Americana em Ciências da Saúde, Latin American and Caribbean Health Sciences Literature) and Embase from inception to October 2015. RESULTS: A significant increase in cure rates, by 18% with DOTS and by 16% with patient education and counselling, was observed. In addition, the default rate decreased by 49% with DOTS, by 26% with financial incentives and by 13% with patient education and counselling. There was no statistically significant reduction in mortality rates with these interventions. CONCLUSION: Use of DOTS and patient education/counselling significantly improved cure rates; DOTS, patient education/counselling and financial incentives led to a reduction in the default rate.