Clinical Evaluation of Active Tuberculosis-Related Deaths in Shenzhen, China: A Descriptive Study

Peize Zhang,1,* Juan Xiong,2,* Jianfeng Zeng,1,* Senlin Zhan,1 Tao Chen,1 Yuxiang Wang,1 Guofang Deng1 1Department of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, People’s Republic of China; 2School of Public Health, Health Science Center, Shenzhen University, Shenzhen, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guofang DengDepartment of Pulmonary Medicine and Tuberculosis, The Third People’s Hospital of Shenzhen, No. 29, Bulan Road, Longgang District, Shenzhen, Guangdong 518112, People’s Republic of ChinaTel +86 135 300 27001Fax +86 0755 6123 8928Email jxxk1035@yeah.netObjective: The aim of this study was to assess active tuberculosis-related deaths in Shenzhen city of China to identify major causes of mortality in different age groups.Patients and Methods: Medical records of mortality cases of patients with active TB diagnosed during 2013– 2018 were reviewed. All TB deaths were classified into two broad age groups (the young group: 18– 65 years old and the elderly group: > 65 years old). Causes of death were analyzed based on medical records.Results: A total of 279 mortality cases of active TB were reviewed during the study period. Among them, mean age was 54.0± 20.5 years old; 80.6% (225/279) were male. There were 5.7% and 4.6% MDR/XDRTB patients in the young and elderly group. Newly treated TB accounted for 89.6% in the young group and 85.1% in the elderly group. Pulmonary TB was a major infection type in both groups (65.1% vs 77.0%). Advanced TB (23.4%) and HIV co-infection (20.8%) were the leading causes of deaths in the young group, but deaths in the elderly group were mostly associated with underlying diseases, including cardiovascular disease (52.9%), diabetes (33.3%), COPD (16.1%) and cancer (11.5%). Malnutrition was a significant condition in both groups (43.2% vs 35.6%). In terms of respiratory complications, bacterial infection was the leading comorbidity in both groups (27.1% vs 18.4%), followed by septic shock (18.2% vs 12.6%) and respiratory failure (12.0% vs 11.5%). There were no significant statistical differences between the two groups.Conclusion: Our findings suggest that screening for HIV co-infection and early diagnosis of TB is vital in lowering TB-related deaths in young patients. Most deaths in elderly TB patients were caused by underlying health conditions or complications other than TB.Keywords: active tuberculosis, TB-related death, tuberculosis complication, tuberculosis comorbidity, young death