Abstract
BackgroundTuberculosis remains an important health concern in many countries. The aim of this study was to identify predictors of unfavorable outcomes at the end of treatment (EOT) and at the end of study (EOS; 40 months after EOT) in South Korea.MethodsNew or previously treated tuberculosis patients were recruited into a prospective observational cohort study at two hospitals in South Korea. To identify predictors of unfavorable outcomes at EOT and EOS, logistic regression analysis was performed.ResultsThe proportion of multidrug-resistant tuberculosis (MDR-TB) was 8.2% in new cases and 57.9% in previously treated cases. Of new cases, 68.6% were cured, as were 40.7% of previously treated cases. At EOT, diabetes, ≥3 previous TB episodes, ≥1 significant regimen change, and MDR-TB were significantly associated with treatment failure or death. At EOS, age ≥35, body-mass index (BMI) <18.5, diabetes, and MDR-TB were significantly associated with treatment failure, death, or relapse. Among cases that were cured at EOT, age ≥50 and a BMI <18.5 were associated with subsequent death or relapse during follow-up to EOS. Treatment interruption was associated with service sector employees or laborers, bilateral lesions on chest X-ray, and previous treatment failure or treatment interruption history.ConclusionsRisk factors for poor treatment outcomes at EOT and EOS include both patient factors (diabetes status, age, BMI) and disease factors (history of multiple previous treatment episodes, MDR-TB). In this longitudinal, observational cohort study, diabetes mellitus and MDR-TB were risk factors for poor treatment outcomes and relapse. Measures to help ensure that the first tuberculosis treatment episode is also the last one may improve treatment outcomes.Trial registrationClinicalTrials.gov ID: NCT00341601
Highlights
Tuberculosis remains an important health concern in many countries
Baseline and treatment characteristics A total of 669 patients were enrolled in the study from 2005-2012, 563 (84.2%) of whom were male with a median age of 44 years
The multivariate analysis of baseline risk factors associated with unfavorable outcomes at end of treatment (EOT) included diabetes (OR = 2.52; 95% CI = 1.275.01), patients drinking several times a week (OR = 0.38: 95% CI = 0.16-0.93, compared to drinking less than once a week), ≥1 significant regimen changes (OR = 4.01; 95% CI = 2.16-7.44), multidrug-resistant tuberculosis (MDR-TB) (OR = 2.75; 95%CI = 1.13-6.72, compared to drug-sensitive TB), and patients with 3 or ≥4 previous treatment episodes
Summary
Tuberculosis remains an important health concern in many countries. Tuberculosis (TB), a global concern for both developing and developed countries, has recently become more complex due to increasing levels of drug resistance and HIV co-infection [1]. Asian and African countries share the highest burden of tuberculosis, accounting for about. Efforts to reduce disease burden have been largely focused on improving treatment and diagnosis of patients with active disease [3]. HIV co-infection and multidrug-resistant (MDR) TB are major contributors to the global TB epidemic [4], a deeper understanding of other risk factors for poor outcome can suggest interventions that might help reduce morbidity and mortality. Poor socioeconomic status, including poverty, lack of education, and urbanization are known risk factors for active tuberculosis Variables Group (%) P-.
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