Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects
Published Date:Jul 10 2012
Source:Tuberculosis (Edinb). 92(5):397-403.
Body Mass Index
Directly Observed Therapy
Outcome Assessment (Health Care)
Predictive Value Of Tests
Pubmed Central ID:PMC4749016
Funding:CC999999/Intramural CDC HHS/United States
Objective of this analysis was to identify predictors of death, failure, and default among MDR-TB patients treated with second-line drugs in DOTS-plus projects in Estonia, Latvia, Philippines, Russia, and Peru, 2000–2004.
Risk ratios (RR) with 95% confidence intervals (CI) were calculated using multivariable regression.
Of 1,768 patients, treatment outcomes were: cure/completed – 1,156 (65%), died – 200 (11%), default - 241 (14%), failure - 118 (7%). Independent predictors of death included: age>45 years (RR=1.90 (95%CI 1.29–2.80), HIV infection (RR=4.22 (2.65–6.72)), extrapulmonary disease (RR=1.54 (1.04–2.26)), BMI<18.5 (RR=2.71 (1.91–3.85)), previous use of fluoroquinolones (RR=1.91 (1.31–2.78)), resistance to any thioamide (RR=1.59 (1.14–2.22)), baseline positive smear (RR=2.22 ()1.60–3.10), no culture conversion by 3rd month of treatment (RR=1.69 (1.19–2.41)); failure: cavitary disease (RR=1.73 (1.07–2.80)), resistance to any fluoroquinolone (RR=2.73 (1.71–4.37)) and any thioamide (RR=1.62 (1.12–2.34)), and no culture conversion by 3rd month (RR=5.84 (3.02–11.27)); default: unemployment (RR=1.50 (1.12–2.01)), homelessness (RR=1.52 (1.00–2.31)), imprisonment (RR=1.86 (1.42–2.45)), alcohol abuse (RR=1.60 (1.18–2.16)), and baseline positive smear (RR=1.35 (1.07–1.71)).
Patients with biomedical risk factors for treatment failure or death should receive heightened medical attention. To prevent treatment default, management of patients who are unemployed, homeless, alcoholic, or have a prison history requires extra measures to insure treatment completion.
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