Predictors for Mortality in Multidrug Resistant Pulmonary Tuberculosis Patients in a South Indian Region
Abstract
Background: Although various factors depicting the mortality in multi drug resistant tuberculosis available there exist no concise data on the factors contributing to mortality globally. The predictors for mortality in multi drug resistant tuberculosis patients vary from localities.
Objectives: The study aimed to find the factors contributing to mortality in multi drug resistant tuberculosis in Warangal district of Telangana.
Materials and Methods: The prospective study determining the predictors of mortality in multidrug resistant pulmonary tuberculosis patients had a sample size of 296. The follow-up of the patients was conducted for twenty four months to determine the treatment outcome. Patients’ mortality was noted from the hospital case sheets, relatives and healthcare facilitators’ viz., National tuberculosis elimination program supervisors, Auxiliary Nursing Midwifery in case of death at home. Patients’ demography was denoted in number and percentage. Predictors for mortality determined using binary logistic regression analysis. The predictor variables significant with p<0.2 in univariate analysis were considered for binary logistic regression analysis. The dependent variable was the occurrence of event - mortality and the independent variables chosen from the available literature.
Results: The predictors for mortality identified as low body weight of 16-30kg (p=0.002; aOR=10.43); comorbids (p=0.002; aOR=3.21); severe radiological manifestations at admission to hospital (p=0.001; aOR=6.98) and incompliance to treatment (p=0.0001; aOR=5.06) in the present study.
Conclusion: The factors identified for mortality in multidrug resistant tuberculosis patients are malleable and modifiable with timely follow-up of the patients. The results imply strengthening the anti-TB program with a multidisciplinary approach for a systematic follow-up of the patients and favorable treatment responses.
How to cite this article:
T Smitha, O Prabhakar. Predictors for Mortality in Multidrug Resistant Pulmonary Tuberculosis Patients in a South Indian Region. J Commun Dis. 2022;54(4):62-68.
DOI: https://doi.org/10.24321/0019.5138.202304
References
WHO. Global Tuberculosis Report. Geneva, Switzerland World Health Organization. 2019.
Directorate of Health Services, Ministry of Health & Family Welfare, Government of India CTD. National Anti-TB Drug Resistance Survey.pdf. 2018.
WHO. Global tuberculosis report. Geneva World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO. 2021.
Chuang CU, Van Weezennbeek C, Mori T, Enaeso DA. Challenges to the global control of tuberculosis. Respirology. 2013;18:596-604. [PubMed] [Google Scholar]
Glaziou P, Falzon D, Floyd K, Raviglione M. Global epidemiology of tuberculosis. Semin Respir Crit Care Med. 2013;34(1):3-16. [PubMed] [Google Scholar]
World Health Organization. Global tuberculosis control surveillance, planning, financing: WHO report. World Health Organization. 2008. Available from: https://apps.who.int/iris/handle/10665/43831
Bei C, Fu M, Zhang Y, Xie H, Yin K, Liu Y, Zhang L, Xie B, Li F, Huang H, Liu Y, Yang L, Zhou J. Mortality and associated factors of patients with extensive drugresistant tuberculosis an emerging public health crisis in China. BMC Infect Dis. 2018;18(1):261. [PubMed] [Google Scholar]
World Health Organization. Global Tuberculosis Report. Geneva World Health Organization. Contract No. WHO/HTM/TB. 2016.
Schnippel K, Berhanu RH, Black A, Firnhaber C, Maitisa N, Evans D, Sinanovic E. Severe adverse events during second-line tuberculosis treatment in the context of high HIV Co-infection in South Africa a retrospective cohort study. BMC Infect Dis. 2016;16(1):593. [PubMed] [Google Scholar]
Tefera KT, Mesfin N, Reta MM, Sisay MM, Tamirat KS, Akalu TY. Treatment delay and associated factors among adults with drug resistant tuberculosis at treatment initiating centers in the Amhara regional state, Ethiopia. BMC Infect Dis. 2019;19(1):489. [PubMed] [Google Scholar]
Kassa GM, Tadesse A, Gelaw YA, Alemayehu TT, Tsegaye AT, Tamirat KS, Akalu TY. Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia a retrospective follow-up study. Epidemiol Infect. 2020;148:e258. [PubMed] [Google Scholar]
Tola H, Holakouie-Naieni K, Mansournia MA, Yaseri M, Gamtesa DF, Tesfaye E, Mahamed Z, Sisay MM. National treatment outcome and predictors of death and treatment failure in multidrug-resistant tuberculosis in Ethiopia a 10-year retrospective cohort study. BMJ Open. 2021;11(8):e040862. [PubMed] [Google Scholar]
Samuels JP, Sood A, Campbell JR, Ahmad Khan F, Johnston JC. Comorbidities and treatment outcomes in multidrug resistant tuberculosis a systematic review and meta-analysis. Sci Rep. 2018;8(1):4980. [PubMed] [Google Scholar]
Singh A, Prasad R, Kushwaha RAS, Srivastava R, Giridhar BH, Balasubramanian V, Jain A. Treatment outcome of multidrug-resistant tuberculosis with modified DOTS-plus strategy. A 2 years’ experience. Lung India. 2019;36(5):384-92. [PubMed] [Google Scholar]
Central TB Division. National Strategic Plan for Tuberculosis Elimination. Dir Gen Heal Serv Minist Heal Fam Welf. 2017:110-08.
Guidelines for Programmatic Management of Drug resistant Tuberculosis in India. Central TB Elimination Program. Directorate of Health Services, Ministry of Health & Family Welfare, Government of India CTD. 2021.
Liu CH, Li L, Chen Z, Wang Q, Hu YL, Zhu B, Woo PC. Characteristics and treatment outcomes of patients with MDR and XDR tuberculosis in a TB referral hospital in Beijing a 13-year experience. PLoS One. 2011;6(4):e19399. [PubMed] [Google Scholar]
Soeroto AY, Pratiwi C, Santoso P, Lestari BW. Factors affecting outcome of longer regimen multidrugresistant tuberculosis treatment in West Java Indonesia. A retrospective cohort study. PLoS One. 2021;16(2):e0246284. [PubMed] [Google Scholar]
Wen Y, Zhang Z, Li X, Xia D, Ma J, Dong Y, Zhang X. Treatment outcomes and factors affecting unsuccessful outcome among new pulmonary smear positive and negative tuberculosis patients in Anqing, China. A retrospective study. BMC Infect Dis. 2018;18(1):104. [PubMed] [Google Scholar]
Pizzol D, Di Gennaro F, Chhaganlal KD, Fabrizio C, Monno L, Putoto G, Saracino A. Prevalence of diabetes mellitus in newly diagnosed pulmonary tuberculosis in Beira, Mozambique. Afr Health Sci. 2017;17(3):773-9. [PubMed] [Google Scholar]
Van Deun A, Maug AK, Salim MA, Das PK, Sarker MR, Daru P, Rieder HL. Short, highly effective, and inexpensive standardized treatment of multidrugresistant tuberculosis. Am J Respir Crit Care Med. 2010;182(5):684–92. [PubMed] [Google Scholar]
Scrimshaw NS, SanGiovanni JP. Synergism of nutrition, infection, and immunity an overview. Am J Clin Nutr. 1997;66:464S-77S. [PubMed] [Google Scholar]
Warner DF. Mycobacterium tuberculosis metabolism. Cold Spring Harb Perspect Med. 2014;5(4):a021121-a021121.
Chang SW, Pan WS, Lozano Beltran D, Oleyda Baldelomar L, Solano MA, Tuero I, Friedland JS, Torrico F, Gilman RH. Gut Hormones, Appetite suppression and cachexia in patients with pulmonary TB. PLoS One. 2013;8(1):e54564. [PubMed] [Google Scholar]
Diallo A, Diallo BD, Camara LM, Kounoudji LAN, Bah B, N’Zabintawali F, Carlos-Bolumbu M, Diallo MH, Sow OY. Different profiles of body mass index variation among patients with multidrug-resistant tuberculosis. A retrospective cohort study. BMC Infect Dis. 2020;20(1):315. [PubMed] [Google Scholar]
Parmar MM, Sachdeva KS, Dewan PK, Rade K, Nair SA, Pant R, Khaparde SD. Unacceptable treatment outcomes and associated factors among India’s initial cohorts of multidrug-resistant tuberculosis (MDRTB) patients under the revised national TB control programme. Evidence leading to policy enhancement. PLoS One. 2018;13(4):e0193903. [PubMed] [Google Scholar]
Dash M, Behera BP. Socioepidemiological status and clinical outcome of MDR TB patients in a tertiary medical college in Southern Odisha. J Family Med Prim Care. 2022;11(4):1275-81. [PubMed] [Google Scholar]
Nijland HM, Ruslami R, Stalenhoef JE, Nelwan EJ, Alisjahbana B, Nelwan RH, van der Ven AJ, Danusantoso H, Aarnoutse RE, van Crevel R. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis. 2006;43(7):848-54. [PubMed] [Google Scholar]
Lönnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic From evidence to policy and practice. Lancet Diabetes Endocrinol. 2014;2(9):730-9. [PubMed] [Google Scholar]
Gashu KD, Gelaye KA, Lester R, Tilahun B. Effect of a phone reminder system on patient-centered tuberculosis treatment adherence among adults in northwest Ethiopia. A randomised controlled trial. BMJ Health Care Inform. 2021;28(1):e100268. [PubMed] [Google Scholar]
World Health Organization. Adherence to longterm therapies evidence for action. World Health Organization, 2003. Available from: https://apps.who.int/iris/handle/10665/42682 [Google Scholar]
Thomas BE, Kumar JV, Periyasamy M, Khandewale AS, Hephzibah Mercy J, Raj EM, Kokila S, Walgude AS, Gaurkhede GR, Kumbhar JD, Ovung S, Paul M, Rajkumar BS, Subbaraman R. Acceptability of the medication event reminder monitor for promoting adherence to multidrug-resistant tuberculosis therapy in two Indian cities. Qualitative study of patients and health care providers. J Med Internet Res. 2021;23(6):e23294. [PubMed] [Google Scholar]
Copyright (c) 2022 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.