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

Ekaterina V. Kurbatova; Allison Taylor; Victoria M. Gammino; Jaime Bayona; Mercedes Becerra; Manfred Danilovitz; Dennis Falzon; Irina Gelmanova; Salmaan Keshavjee; Vaira Leimane; Carole D. Mitnick; Ma Imelda Quelapio; Vija Riekstina; Piret Viiklepp; Matteo Zignol; J. Peter Cegielski

doi:10.1016/j.tube.2012.06.003

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

Ekaterina V. Kurbatova^*
, Allison Taylor
, Victoria M. Gammino
, Jaime Bayona
, Mercedes Becerra
, Manfred Danilovitz
, Dennis Falzon
, Irina Gelmanova
, Salmaan Keshavjee
, Vaira Leimane
, Carole D. Mitnick
, Ma Imelda Quelapio
, Vija Riekstina
, Piret Viiklepp
, Matteo Zignol
, J. Peter Cegielski

^*Corresponding author for this work

Centers for Disease Control and Prevention
Harvard University
Eye Clinic of Tartu University Hospital
World Health Organization
Riga East University Hospital
Tropical Disease Foundation
National Institute for Health Development

Research output: Contribution to journal › Article › peer-review

135 Citations (Scopus)

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.

Original language	English
Pages (from-to)	397-403
Number of pages	7
Journal	Tuberculosis
Volume	92
Issue number	5
DOIs	https://doi.org/10.1016/j.tube.2012.06.003
Publication status	Published - Sept 2012
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Multidrug-resistant tuberculosis
Risk factors
Treatment outcomes

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10.1016/j.tube.2012.06.003

Cite this

Kurbatova, E. V., Taylor, A., Gammino, V. M., Bayona, J., Becerra, M., Danilovitz, M., Falzon, D., Gelmanova, I., Keshavjee, S., Leimane, V., Mitnick, C. D., Quelapio, M. I., Riekstina, V., Viiklepp, P., Zignol, M., & Cegielski, J. P. (2012). Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects. Tuberculosis, 92(5), 397-403. https://doi.org/10.1016/j.tube.2012.06.003

@article{04c9127cef8f4fdab595f44b22982d9a,

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

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.",

keywords = "Multidrug-resistant tuberculosis, Risk factors, Treatment outcomes",

author = "Kurbatova, \{Ekaterina V.\} and Allison Taylor and Gammino, \{Victoria M.\} and Jaime Bayona and Mercedes Becerra and Manfred Danilovitz and Dennis Falzon and Irina Gelmanova and Salmaan Keshavjee and Vaira Leimane and Mitnick, \{Carole D.\} and Quelapio, \{Ma Imelda\} and Vija Riekstina and Piret Viiklepp and Matteo Zignol and Cegielski, \{J. Peter\}",

year = "2012",

month = sep,

doi = "10.1016/j.tube.2012.06.003",

language = "English",

volume = "92",

pages = "397--403",

journal = "Tuberculosis",

issn = "1472-9792",

publisher = "Churchill Livingstone",

number = "5",

}

Kurbatova, EV, Taylor, A, Gammino, VM, Bayona, J, Becerra, M, Danilovitz, M, Falzon, D, Gelmanova, I, Keshavjee, S, Leimane, V, Mitnick, CD, Quelapio, MI, Riekstina, V, Viiklepp, P, Zignol, M & Cegielski, JP 2012, 'Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects', Tuberculosis, vol. 92, no. 5, pp. 397-403. https://doi.org/10.1016/j.tube.2012.06.003

TY - JOUR

T1 - Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects

AU - Kurbatova, Ekaterina V.

AU - Taylor, Allison

AU - Gammino, Victoria M.

AU - Bayona, Jaime

AU - Becerra, Mercedes

AU - Danilovitz, Manfred

AU - Falzon, Dennis

AU - Gelmanova, Irina

AU - Keshavjee, Salmaan

AU - Leimane, Vaira

AU - Mitnick, Carole D.

AU - Quelapio, Ma Imelda

AU - Riekstina, Vija

AU - Viiklepp, Piret

AU - Zignol, Matteo

AU - Cegielski, J. Peter

PY - 2012/9

Y1 - 2012/9

N2 - 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.

AB - 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.

KW - Multidrug-resistant tuberculosis

KW - Risk factors

KW - Treatment outcomes

UR - https://www.scopus.com/pages/publications/84865514086

U2 - 10.1016/j.tube.2012.06.003

DO - 10.1016/j.tube.2012.06.003

M3 - Article

C2 - 22789497

AN - SCOPUS:84865514086

SN - 1472-9792

VL - 92

SP - 397

EP - 403

JO - Tuberculosis

JF - Tuberculosis

IS - 5

ER -

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

Abstract

UN SDGs

Keywords

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