Risk Factors for Death during Pulmonary Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort Study

Abstract

The data regarding risk factors for death during tuberculosis (TB) treatment are inconsistent, and few studies examined this issue in Korea. The purpose of this study was to evaluate baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients who received TB treatment at eight hospitals from January 2009 to December 2010 was performed. Successful treatment included cure (1,129, 45.5%) and treatment completion (1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85, 3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariate analysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive care unit (ICU) admission were significant risk factors for death during TB treatment. Therefore, male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission could be baseline prognostic factors for death during treatment of adult patients with pulmonary TB in Korea.Graphical Abstract

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil

“…Several factors influence treatment adherence, from high incidence of adverse drug events, to direct/indirect associated costs and stigmatization [ 3 , 6 – 8 ]. Regarding TB treatment outcomes, some risk factors have been associated with unsuccessful outcome of treatment, such as: age [ 9 – 12 ], male gender [ 9 , 13 ], race [ 10 ], being an immigrant [ 10 ], illiteracy [ 14 ], malnutrition [ 12 ], HIV positivity [ 9 , 12 , 14 – 17 ], chronic comorbidities [ 12 , 13 , 18 ], and socioeconomic factors [ 12 , 16 ]. Some factors such as diabetes mellitus and smoking have been associated more frequently with relapse, treatment failure, and death [ 12 , 19 – 21 ], while drug use and alcohol use were associated with loss to follow-up and death [ 15 , 19 ].…”

Treatment of Drug Susceptible Pulmonary Tuberculosis

“…M. tuberculosis has characteristics distinct from other bacteria, including slow growth, with generation times of 15 to 20 hours and a capacity for dormancy that requires prolonged treatment to confirm successful eradication 22 . Moreover, this organism can actively multiply in the liquid caseous debris of pulmonary cavities, which may contain up to 10 8 organisms 22 . Drug resistance could be achieved by random genetic point mutation; it is also possible that the large population of organisms in such cavities could have the potential for drug resistance 22 .…”

“…The standard four-drug (2HREZ/4HR) regimen has shown high efficacy in achieving cure rates around 90%-95%, both in treatment under oversight of TB control programs and trial conditions 24 . A recent multicenter retrospective cohort study was conducted in Korea, including a total of 2,481 patients with pulmonary TB and excluding patients with treatment default, those who were transferred to another hospital, had unknown treatment outcome, and had positive human immunodeficiency virus antibodies; successful treatment was achieved for 2,333 patients (94%), who comprised those being cured (45.5%) and completing treatment (48.5%) 8 . However, the treatment success fate of all reported TB patients in Korea is still low, that is, less than 70%; this low success rate is mainly caused by patients with treatment default and for whom there is an unknown treatment outcome 5 .…”

“…TB also has the highest mortality rate among the infectious diseases; it was 4.9/100,000 persons in 2012 3 4 5 6 7 . In pulmonary TB patients, the mortality rate during TB treatment reached 3.4% in a recent multicenter study 8 .…”

“…Therefore, there are challenges in the current TB treatment such as shortening the treatment duration, increasing adherence, and managing adverse drug effects. This article covers current TB treatment in patients with newly diagnosed drug-susceptible pulmonary TB based on the Korean Guidelines for Tuberculosis, second edition, 2014 10 and recent clinical studies for TB treatment 8 11 12 13 14 15 16 17 18 19 20 .…”