Risk Factors and Outcomes for Tuberculosis Patients Requiring Hospital Admission

Abstract

Objectives: To identify the factors associated with outcomes including mortality in hospitalized tuberculosis patients at a tertiary care Hospital.

Methodology: This retrospective-prospective observational study was conducted at Indus Hospital and Health Network (IHHN), Karachi from June 2024-May 2025. All admitted patients aged 14 to 70 years; both genders with diagnosis of tuberculosis (pulmonary and extra-pulmonary) were included. Enrolled patients were prospectively assessed at admission and followed throughout hospitalization, while data for retrospectively identified patients were obtained from the Hospital medical records, using a structured proforma.  Outcomes were assessed for risk factors and outcomes in terms of death or survival to discharge. All the relevant data were analyzed by using SPSS version 26.

Results: Overall, 202 hospitalized patients were enrolled, the cohort was predominantly young (32% aged 15–25 years) with a slight predominance of females (54.5%), most cases had microbiologically confirmed TB (82.2%), with 41% having disseminated TB, 27% PTB, and 32.5% EPTB. Fever was the most common presenting symptom (77.7%). Overall, in hospital mortality was 15.3%, but was significantly higher among ICU patients (86.7%). The demographic factors such as age, gender and BMI did not show significant association with mortality (p>0.05). Comorbidities included diabetes (14.4%), hypertension (9.4%), CKD (7.9%), and HIV (5%). Disseminated TB was strongly linked to mortality, approximately 77.4% of non-survivors compared to 34.5% of survivors (p<0.0001). Non-survivors also had significantly higher rates of in-hospital complications, including mechanical ventilation (80% vs. 7.1%), vasopressor requirement (80% vs. 6.5%), AKI (73.3% vs. 8.3%), and disseminated intravascular complications (40% vs. 5.3%) (p=0.001). 

Conclusions: Morality rate was observed 15.3%, with delayed presentation, disseminated tuberculosis and the development of in-hospital complications, particularly mechanical ventilation, vasopressor requirement, AKI, disseminated intravascular complications, and decreased albumin level as key determinants of the in-hospital mortality.