A Matched Case-Control Study to Stratify Mortality Risk Factors in Adult Pulmonary Tuberculosis Patients in Northeast of Thailand - การศึกษาปัจจัยที่มีอิทธิพลต่อการเสียชีวิตในผู้ป่วยวัณโรคปอดผู้ใหญ่ ภาคตะวันออกเฉียงเหนือ ประเทศไทย: ศึกษาแบบ Matched Case-Control

Abstract

             The mortality rate of tuberculosis (TB) patients between 2014-18 is higher than the national average and is predicted to increase in Roi Et, Khon Kaen, Maha Sarakham and Kalasin provinces in the Northeast area. This study aimed to analyze the risk factors associated with death during the treatment of pulmonary TB patients to provide policy recommendations for prevention and control measures. A matched case-control study was conducted between October 2016 and September 2017. The fatal cases 340 with the control 680 cases were randomly assigned. Control factors were the start-up period not exceeding 2 weeks and treatment provided at the same hospital. Clinical data collection came from medical records and interview. Results from multiple logistic regressions revealed a statistically significant relationship in elderly people over 65 years old [OR 3.61 (95%CI 2.12-6.12, p<0.01)], patients with chronic kidney disease (CKD) [OR 4.34 (95%CI 1.62-11.62, p<0.01)], patients with history of anorexia before treatment [OR 2.55 (95%CI 1.18-5.50, p<0.02)], and patients who started the treatment differed from the standard treatment category [OR 3.92 (95%CI 1.52-10.10, p<0.01)]. Hospitalized cases at the date of treatment with severe symptoms had an OR of 10.58 (95%CI 4.90-22.83, p<0.01). In conclusion, CKD is a major risk factor for mortality to be different from previous studies that HIV infection. The key process to reducing mortality should be to provide close supervision in the hospital, particularly for vulnerablegroups, and to establish a physician alert system to ensure standardized treatment in all new cases of TB.

Key words: pulmonary tuberculosis patients, matched case-control study, mortality risk factors, Thailand