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Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: an optimized prediction model

  • X.-M. WANG (a1), S.-H. YIN (a1), J. DU (a2), M.-L. DU (a1), P.-Y. WANG (a3), J. WU (a4), C. M. HORBINSKI (a5), M.-J. WU (a5), H.-Q. ZHENG (a1), X.-Q. XU (a1), W. SHU (a2) and Y.-J. ZHANG (a6)...

Retreatment of tuberculosis (TB) often fails in China, yet the risk factors associated with the failure remain unclear. To identify risk factors for the treatment failure of retreated pulmonary tuberculosis (PTB) patients, we analyzed the data of 395 retreated PTB patients who received retreatment between July 2009 and July 2011 in China. PTB patients were categorized into ‘success’ and ‘failure’ groups by their treatment outcome. Univariable and multivariable logistic regression were used to evaluate the association between treatment outcome and socio-demographic as well as clinical factors. We also created an optimized risk score model to evaluate the predictive values of these risk factors on treatment failure. Of 395 patients, 99 (25·1%) were diagnosed as retreatment failure. Our results showed that risk factors associated with treatment failure included drug resistance, low education level, low body mass index (<18·5), long duration of previous treatment (>6 months), standard treatment regimen, retreatment type, positive culture result after 2 months of treatment, and the place where the first medicine was taken. An Optimized Framingham risk model was then used to calculate the risk scores of these factors. Place where first medicine was taken (temporary living places) received a score of 6, which was highest among all the factors. The predicted probability of treatment failure increases as risk score increases. Ten out of 359 patients had a risk score >9, which corresponded to an estimated probability of treatment failure >70%. In conclusion, we have identified multiple clinical and socio-demographic factors that are associated with treatment failure of retreated PTB patients. We also created an optimized risk score model that was effective in predicting the retreatment failure. These results provide novel insights for the prognosis and improvement of treatment for retreated PTB patients.

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*Author for correspondence: Maolin Du, Inner Mongolia Medical University, Hohhot, China. (Email:
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These authors contributed equally to this work.

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10. J Volmink , P Garner . Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment. BMJ (Clinical Research edn) 1997; 315(7120): 14031406.

12. LM Sullivan , JM Massaro , RB. D'Agostino Sr Presentation of multivariate data for clinical use: the Framingham Study risk score functions. Statistics in Medicine 2004; 23(10): 16311660.

16. RB D'Agostino , Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke; a Journal of Cerebral Circulation 1994; 25(1): 4043.

18. BC Goldstein LB , RJ Adams , LJ Appel , LT Braun , S Chaturvedi , MA Creager , A Culebras , RH Eckel , RG Hart , JA Hinchey , VJ Howard , EC Jauch , SR Levine , JF Meschia , WS Moore , JV Nixon , TA Pearson ; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Epidemiology and Prevention; Council for High Blood Pressure Research; Council on Peripheral Vascular Disease and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42(2): 517584.

19. H Wang , Longitudinal association of dairy consumption with the changes in blood pressure and the risk of incident hypertension: the Framingham Heart Study. The British journal of nutrition 2015; 114(11): 18871899.

20. ST Jacob , PB Pavlinac , L Nakiyingi , P Banura , JM Baeten , K Morgan , Mycobacterium tuberculosis Bacteremia in a Cohort of HIV-infected patients hospitalized with severe sepsis in Uganda–high frequency, low clinical sand derivation of a Clinical Prediction Score. PLoS ONE 2013; 8(8): e70305.

21. PH Joshi , Remnant lipoprotein cholesterol and incident coronary heart disease: the Jackson Heart and Framingham Offspring Cohort Studies. Journal of the American Heart Association 2016; 5(5).

22. NI Parikh , A risk score for predicting near-term incidence of hypertension: the Framingham Heart Study. Annals of Internal Medicine 2008; 148(2): 102110.

23. S Chen , Risk factors for multidrug resistance among previously treated patients with tuberculosis in eastern China: a case–control study. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases 2013; 17(12): e11161120.

24. J Lenjisa . Assessment of tuberculosis retreatment case rate and its treatment outcomes at Adama Hospital Medical College, East Showa, Ethiopia. Journal of Steroids & Hormonal Science 2015; 06(1).

25. EC Jones-Lopez , Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda: a prospective cohort study. PLoS Medicine 2011; 8(3): e1000427.

26. SG Mpagama , The influence of mining and human immunodeficiency virus infection among patients admitted for retreatment of tuberculosis in Northern Tanzania. The American Journal of Tropical Medicine and Hygiene 2015; 93(2): 212215.

27. AL Kritski , Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest 1997; 111(5): 11621167.

28. MA Espinal , Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries. Jama 2000; 283(19): 25372545.

29. GX He , Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment. PLoS ONE 2010; 5(5): e10799.

31. A Mak , Influence of multidrug resistance on tuberculosis treatment outcomes with standardized regimens. American Journal of Respiratory and Critical care Medicine 2008; 178(3): 306312.

32. A Faustini , AJ Hall , CA Perucci . Risk factors for multidrug resistant tuberculosis in Europe: a systematic review. Thorax 2006; 61(2): 158163.

33. H Choi , Predictors of pulmonary tuberculosis treatment outcomes in South Korea: a prospective cohort study, 2005–2012. BMC Infectious Diseases 2014; 14(1): 360.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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