Factores de riesgo para mortalidad por tuberculosis pulmonar en el Instituto Nacional de Enfermedades Respiratorias. México. 2006-2008

Abstract

Introduction: Mortality is an indicator associated with epidemiological, clinical and health services, among others. Identifiable variables studied in the clinical records of patients whose death occurred during their hospital stay for pulmonary tuberculosis (PTB). Objective: To identify epidemiological, clinical, bacteriological and pharmacological TBP associated with death in patients hospitalized in INER. Material and methods: Observational, analytical, retrospective case-control study. Study population: Patients aged ≥ 18 years with TBP diagnosed by smear and / or culture, in the INER hospitalized during 2006-2008. They were chosen at a rate of 1:3 cases and controls. The cases were who were died from any cause in the INER and the controls, who were discharged alive. Results: During the period of our study were discharged a total of 512 patients over 18 with tuberculosis or its sequelae, among which, 56 died as a result, met the selection criteria 32 cases and 95 controls were selected. 59.1% were male, mean age of 48.9 years (SD ± 18.6). Were identified as risk factors for death: male gender [OR 5.29 (95% CI 3.11-7.46) p = 0.002], age 60 years [OR: 1.08 (95% CI 1.00-1.16) p = 0.001], illiteracy, smoking [OR: 2.75 (95% CI 1.71-3.78) p = 0.025], the average number of comorbilities (p = 0.025), malnutrition [OR: 4.36 (95% CI 2.96-5.75) p = 0.002], bronchiectasis [OR: 1.53 ( 95% CI 1.14-1.93) p = 0.034] and pneumonia [OR: 36.78 (95% CI 33.14-40.43) p <0.001]. Other causes direct or associated of death were diabetes (34.4%), septic shock (31.3%), HIV infection (25%) and pneumonia (18.8%). Conclusions: Known risk factors for death in patients with TBP still affecting the mortality rate despite the specialized hospital management, therefore, efforts to modify factors relating to health services should be universal access to quality diagnosis and effective treatment at all levels of care.