Abstract:

Objective: To analyze the clinical characteristics of patients who died of active tuberculosis, to provide a reference basis for reducing case fatality rate of tuberculosis patients. Methods: Demographic information (age, sex) and clinical data (number and days of hospitalizations, tuberculosis infection site, primary or retreatment, drug susceptibility test result, mechanical ventilation or not, comorbidities and complications) of patients who died of active tuberculosis at Shenzhen Third People’s Hospital from 1 January 2013 to 31 December 2022 were retrospectively collected. The patients were divided into young (<44 years), middle-aged (44-59 years), and elderly (≥60 years) groups, and their clinical characteristics were compared. Results: A total of 469 patients died of active tuberculosis, their median (quartile) age was 56 (40, 73) years, there were significantly more males (389 cases (82.94%)) than females (80 cases (17.06%)). Median days of hospitalization was 8.0 (3.0, 22.0) d. The elderly group was the largest group (208 cases (44.35%)), followed by the young group (150 cases (31.98%)), and the least cases were in the middle-aged group (111 cases (23.67%)); Highest number of cases only got pulmonary tuberculosis (351 cases (74.84%)), followed by those with concurrent multi-system tuberculosis (102 cases (21.75%)); Patients with malnutrition (185 cases (39.45%)), cardiovascular disease (159 cases (33.90%)), diabetes mellitus (102 cases (21.75%)), and central nervous system disease (85 cases (18.12%)), HIV infection (69 cases (14.71%)), and those who required mechanical ventilation (100 cases (21.32%)) were very common, whereas the occurrence of drug resistance (17 cases (3.62%)) and retreatment (44 cases (9.38%)), as well as getting both pulmonary tuberculosis and tuberculous meningoencephalitis (21 cases (4.48%)) were not much. Among patients in young, middle-aged and elderly groups, proportions of being male (125 (83.33%), 100 (90.09%) and 164 (78.85%)), getting pulmonary tuberculosis only (93 (62.00%), 83 (74.77%) and 175 (84.13%)) or having multi-system tuberculosis (50 (33.33%), 21 (18.92%) and 31 (14.90%)), combining with malnutrition (79 (52.67%), 44 (39.64%) and 62 (29.81%)), HIV infection (44 (29.33%), 20 (18.02%) and 5 (2.40%)), diabetes (11 (7.33%), 29 (26.13%) and 62 (29.81%)), cardiovascular disease (14 (9.33%), 25 (22.52%) and 120 (57.69%)), chronic lung disease (0 (0.00%), 7 (6.31%) and 39 (19.02%)), liver failure (11 (7.33%), 19 (17.12%) and 15 (7.21%)), stage 5 chronic kidney diseases (4 (2.67%), 9 (8.11%) and 31 (14.90%)), central nervous system diseases (17 (11.33%), 18 (16.22%) and 50 (24.04%)), neoplastic diseases (4 (2.67%), 18 (16.22%) and 38 (18.27%)), and pulmonary infections (121 (80.67%), 75 (67.57%), and 162 (77.88%)) were all significantly different (χ²=6.491, P=0.039; χ²=22.677, P<0.001; χ²=16.475, P<0.001; χ²=19.067, P<0.001; χ²=51.636, P<0.001; χ²=27.503, P<0.001; χ²=99.355, P<0.001; χ²=36.651, P<0.001; χ²=9.487, P=0.009; χ²=15.628, P<0.001; χ²=9.837, P=0.007; χ²=20.544, P<0.001; χ²=6.557, P=0.038). Conclusion: Patients who died of active tuberculosis in tuberculosis specialized hospital were mainly middle-aged and elderly male patients. Among them, young patients’ deaths were mostly due to combining malnutrition, HIV infection and multi-system tuberculosis, whereas for middle-aged and elderly patients, combining multiple underlying diseases may be an important factor of their deaths besides tuberculosis. Therefore, different prevention, control and diagnosis and treatment measures should be adopted for tuberculosis patients in different age groups which could help improving tuberculosis cure rate and lowering case fatality rate.

Key words: Tuberculosis, Death, Age distribution, Disease attributes