Negative tuberculin skin test result predicts all-cause mortality among tuberculosis patients with HIV and diabetes comorbidity

• Type of Material: Article
• Authors: Argita D. Salindri, Georgia State University; Sara Auld, Emory University; Marcos Coutinho Schechter, Emory University; Neel Gandhi, Emory University; Matthew Magee, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2019.02.005
• Title of Journal or Parent Work: Annals of Epidemiology
• Volume: 33
• Start Page: 72
• End Page: 78
• Grant/Funding Information: This work was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health [R03AI133172 to M.J.M, K24AI114444 to N.R.G, and K23AI134182 to S.C.A].
• Keywords: Mortality risk; Diabetes; Risk; Science & Technology; Life Sciences & Biomedicine; Anergy; Pulmonary tuberculosis; Tuberculin skin test; Tuberculosis; Cohort; HIV; Public, Environmental & Occupational Health
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Biology, Biostatistics

Abstract

Purpose: The purpose of this study was to determine if a negative tuberculin skin test (TST) result is associated with increased risk of mortality during tuberculosis (TB) treatment. Methods: We conducted a retrospective cohort study among patients aged ≥15 years with culture-positive TB reported to the Georgia State Electronic Notifiable Disease Surveillance System from 2009 to 2014. TST positivity was defined by the US Centers for Disease Control guidelines. All-cause mortality during TB treatment as well as HIV, diabetes, and end-stage renal disease status were collected from surveillance data. Log-binomial regression was used to estimate adjusted risk ratios and 95% confidence intervals. Results: Among 1186 culture-confirmed TB patients, 780 (65.8%) with a valid TST and TB treatment outcomes were eligible. Nearly one-third (242/780) had a negative TST result, and 5.6% died during treatment. The highest risk of death was observed among patients with a negative TST and HIV (12.5%) and a negative TST and diabetes (15.4%). Adjusting for confounders, the risk of death among patients with a negative TST was significantly greater compared with those with a positive TST (adjusted risk ratio 2.33 95% confidence interval 1.23–4.43). Conclusions: A negative TST was associated with more than twice the risk of mortality during TB treatment after adjusting for immunosuppressive conditions.