Prediction of treatment failure and compliance in patients with tuberculosis

Hyeon-Kyoung Koo,Jinsoo Min,Ju Sang Kim,Sung-Soon Lee,Joosun Lee,Jae Seuk Park,Hyung Woo Kim

doi:10.1186/s12879-020-05350-7

Abstract

BackgroundTo improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. The aim of our study was to describe the characteristics of subjects who had failed treatment of tuberculosis and identify the risk factors for treatment failure and poor compliance using national data.MethodsA multicenter cross-sectional study was performed on tuberculosis subjects whose final outcome was reported as treatment failure during 2015–2017. The same number of subjects with treatment success during the same study period were randomly selected for comparison. Demographics, microbiological, radiographic, and clinical data were collected based on in-depth interviews by TB nurse specialists at all Public Private Mix (PPM) participating hospitals in South Korea.ResultsA total of 52 tuberculosis patients with treatment failure were enrolled. In a multivariable analysis, the presence of diabetes, previous history of tuberculosis, and cavity were identified as risk factors for treatment failure; and Medicaid support was a favorable factor for treatment success (area under the curve [AUC]: 0.79). Age, low body mass index (BMI), presence of diabetes, preexisting lung disease, positive sputum acid-fast bacilli (AFB) smear result, and the presence of multidrug-resistant tuberculosis (MDR-TB) were significantly associated with presence of cavities. Younger age, lower BMI and previous history of TB were associated with poor compliance during treatment (AUC: 0.76).ConclusionTo reduce treatment failure, careful evaluation of the presence of diabetes, previous TB history, underlying lung disease, cavity, results of sputum AFB smears, and socioeconomic status are needed. To enhance treatment compliance, more attention should be paid to younger patients with lower BMIs during follow-up.

Highlights

To improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary
Under the Public Private Mix (PPM) project, all patients are followed during treatment until the report of final treatment outcomes by TB nurse specialists dispatched to private PPM hospitals
In subjects without multidrug-resistant tuberculosis (MDR-TB), the presence of diabetes, previous history of TB (OR = 3.45, 95% Confidence interval (CI): 1.39–8.54), and presence of cavity (OR = 2.74, 95% CI: 0.90–8.36) were selected for predicting treatment failure, and the area under the curve (AUC) of the receiver operating characteristic curve (ROC) curve for this model was 0.73 (Supplemental Figure S3)

Summary

Introduction

To improve treatment outcomes for tuberculosis (TB), efforts to reduce treatment failure are necessary. Human immunodeficiency virus (HIV) co-infection, previous history of TB, sputum smear positivity after 2 months of treatment, male sex, young or advanced age, drug resistance, and residence in a solitary area have been proposed as risk factors for poor outcome [3,4,5,6,7,8,9]. Such studies were performed on a small number of patients in high-TB burden countries with limited medical resources. Because South Korea has a different socioeconomic environment, a low rate of HIV infection, and high access to medical services [10, 11], a different strategy to control TB is required in South Korea

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