P216 Understanding death: the use of a standardised mortality assessment by a UK TB network

Background Reducing TB deaths is an END TB WHO Target. However, in England drug sensitive TB deaths increased from 4.7% in 2013 to 6.1% in 2016. We reviewed TB-related deaths in a large metropolitan TB network to improve care and develop strategies to reduce mortality. Method A mortality audit form was developed to capture relevant clinical and healthcare information in people with TB who had died during their episode of care. This was completed on all deaths by the TB case manager. Results In 2016/17, 691 TB cases were notified. Of the 27 (3.9%) deaths reported, in 22 (81%) TB diagnosis was made in hospital. Age at death ranged from 20–89 years (median 64 years). 52% (14) had pulmonary, 11% (3) pulmonary with extra-pulmonary and 37% (10) extra-pulmonary TB. In 41% (11) death occurred within 4 weeks of starting treatment (table 1). In the 21 patients with drug sensitivity information available, 18 had drug-sensitive and 3 isoniazid-resistant TB. 96% (26) had significant medical co-morbidities. These included: diabetes (8), immune-compromise (4 non-HIV, 2 HIV), chronic respiratory (6), kidney (3) and liver diseases (2). 3 (11%) had one or more social risks for TB (homelessness, alcohol or drug misuse or imprisonment). Reviewing possible system factors contributing to death, treatment was reported as delayed in 7 (26%): 5 due to patient-related and 2 healthcare-related issues. Drug toxicity was noted in 26% (7) – though this was felt to have contributed to only 2 (7%) deaths. Poor treatment adherence was reported in 2 patients. Information on a patient’s death certificate and post-mortem case manager assessment indicated a similar proportion of cases where TB was felt to have caused or contributed to death. For case managers, this was ‘TB caused death’ in 19% (5), and ‘contributed to death’ in 44% (12). Conclusion Diagnostic delays appear to contribute to 1 in 4 deaths. However the majority of people dying with TB have major co-morbidities, and often die early in treatment. This suggests that TB deaths may be unavoidable, and may explain why TB is often not recorded as the primary cause of death on death certificates. CNS – Central Nervous System, EPTB – extra-pulmonary TB, PTB – Pulmonary TB