This retrospective study was designed to assess the pattern of mortality among pulmonary tuberculosis patients and to study various parameters associated with increased risk of death.
369 PTB patients died during last 3 years. were analysed including demographic, clinicoradiological status, duration of illness. Comorbid states were noted. We analysed symptoms at the time of admission, course of progression and terminal events.
Out of 369 PTB pts. (M=273, F=96) who died during last 3 year, 63.1% pts. were in 20–50 yr. age group. Chief complaints were exacerbation of chronic symptoms (cough, fever, breathlessness, chest pain and hemoptysis). 58% patients had TDI of >3 years. 42% were irregular treated and 39% were treated with DOTS, 11% were MDR. 66% males & 58% female had far advanced disease. 36% had at least one destroyed lung. Majority of pts. (48% M & 59% F) had fibrocavitory disease. Comorbid states included COAD/ Asthma (42%) Anemia (83%), DM (22%), HIV infection (5% ), Renal ds. [ARF, CRF, Renal Amyloidosis (6.2%)], Hepatic ds. (3.5%), Ascites (5%) and Bronchogenic Ca. (1.3%). Terminal event was respiratory failure (36%) cor pulmonale (18%), Hemoptysis leading to choking (15%), probabale Thromboembolism/ pulmonary infarction (9%), Renal failure (7%), Hepatitis /Hepatic Coma (5%), TBM (4%), Electrolyte imbalance (4%), Diabetic ketoacidosis / Coma 2% Cause could not be ascertained in 8% cases.
Mortality rate was significantly higher in young adults of low socio-economic status. Mortality rate was directly related to the extent of disease, associated comorbid states, TDI, abject poverty, poor nutritional status, illeteracy & hopelessness. In majority cause of death was respiratory failure, owing to resource constraints diagnosis of PTE/pulmonary infarction could not be confirmed.IMPLICATION: Manageable cause of death should be given top priority in management of these patients. Prophylaxis for airway management in massive haemoptysis, to prevent DVT, management of secondary infections, correction of anaemia and electrolyte imbalance in elderly patients can prevent large number of casualties.
R.C. Gupta, None.