ANALYSIS OF DEATHS FROM PULMONARY TUBERCULOSIS DIAGNOSED FOR THE FIRST TIME IN THE HOSPITAL OF LITHUANIAN UNIVERSITY OF HEALTH SCIENCES KAUNO KLINIKOS BRANCH ROMAINIAI TUBERCULOSIS HOSPITAL

Abstract

  Introduction. With the recommended treatment of drug-susceptible tuberculosis (TB), about 85 percent of TB cases can be successfully treated. When multidrug-resistant TB (MDR–TB) is diagnosed, the likelihood of a successful treatment outcome is lower. However, it has been found that TB treatment outcomes can be determined not only by drug resistance but also by various other factors, such as comorbidities, social factors or the dissemination of TB. Aim of the study. To evaluate what possible risk factors have been identified and may have influenced the death of pulmonary TB patients treated in Lithuanian University of Health Sciences hospital Kaunas Clinics Branch Romainiai Tuberculosis Hospital. Methods. All patients hospitalized at Romainiai TB Hospital from April 2016 to April 2018, who had been bacteriologically confirmed to have pulmonary TB, were diagnosed for the first time in their life and did not have other comorbidities, were asked to participate in this study. Before starting the treatment, the patients filled out the St. George›s Hospital Respiratory Questionnaire (SGRQ), the anamnesis was revised to assess addictions and social factors, a chest x-ray was performed, and the concentrations of C-reactive protein (CRP), albumin, and vitamin D was examined. An X-ray score was calculated according to a validated scale by an experienced radiologist. In the course of the study, two groups of patients were evaluated: successfully treated and dead patients. Statistical analysis was performed using “SPSS v.23.0 Statistical Package for the Social Sciences” (Chicago, IL, USA). The results were considered statistically significant when the statistical reliability (p) was < 0.05. Results. 107 patients were analysed: 93 were successfully treated, and 14 had treatment failure (discontinuation of treatment (7) or death (7). Five dead patients belonged to the drug-susceptible TB group, 1 was poly-drug resistant, and 1 – MDR-TB. Six of the seven patients who died had died within the first month of treatment. Comparing patient groups, significantly worse quality of life and health self-assessment, older age, CRP concentration, X-ray score, lower blood albumin and vitamin D concentrations, lower body mass index (BMI) were found in the deceased group. Conclusions. In-hospital deaths from TB mostly occurred within the first month of treatment. High radiologic spread, low BMI, high CRP and low albumin concentrations in these patients can be seen as signs of prolonged undiagnosed and untreated TB.