Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects

Tuberculosis (Edinb). 2012 Sep;92(5):397-403. doi: 10.1016/j.tube.2012.06.003. Epub 2012 Jul 10.

Abstract

The 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 1768 patients, treatment outcomes were: cure/completed - 1156 (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.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Antitubercular Agents / administration & dosage*
  • Body Mass Index
  • Directly Observed Therapy*
  • Estonia / epidemiology
  • Female
  • HIV Seropositivity / drug therapy
  • HIV Seropositivity / epidemiology*
  • HIV Seropositivity / mortality
  • Humans
  • Latvia / epidemiology
  • Male
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Peru / epidemiology
  • Philippines / epidemiology
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Russia / epidemiology
  • Socioeconomic Factors
  • Substance-Related Disorders / epidemiology*
  • Tuberculosis, Multidrug-Resistant / drug therapy
  • Tuberculosis, Multidrug-Resistant / epidemiology*
  • Tuberculosis, Multidrug-Resistant / mortality

Substances

  • Antitubercular Agents