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Development of a risk score for prediction of poor treatment outcomes among patients with multidrug-resistant tuberculosis


Autoři: Kefyalew Addis Alene aff001;  Kerri Viney aff001;  Darren J. Gray aff001;  Emma S. McBryde aff005;  Zuhui Xu aff006;  Archie C. A. Clements aff003
Působiště autorů: Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia aff001;  Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia aff002;  Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia aff003;  Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden aff004;  Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia aff005;  Department of Tuberculosis Control, Tuberculosis Control Institute of Hunan Province, Changsha city, Hunan Province, China aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0227100

Souhrn

Background

Treatment outcomes among patients treated for multidrug-resistant tuberculosis (MDR-TB) are often sub-optimal. Therefore, the early prediction of poor treatment outcomes may be useful in patient care, especially for clinicians when they have the ability to make treatment decisions or offer counselling or additional support to patients. The aim of this study was to develop a simple clinical risk score to predict poor treatment outcomes in patients with MDR-TB, using routinely collected data from two large countries in geographically distinct regions.

Methods

We used MDR-TB data collected from Hunan Chest Hospital, China and Gondar University Hospital, Ethiopia. The data were divided into derivation (n = 343; 60%) and validation groups (n = 227; 40%). A poor treatment outcome was defined as treatment failure, lost to follow up or death. A risk score for poor treatment outcomes was derived using a Cox proportional hazard model in the derivation group. The model was then validated in the validation group.

Results

The overall rate of poor treatment outcome was 39.5% (n = 225); 37.9% (n = 86) in the derivation group and 40.5% (n = 139) in the validation group. Three variables were identified as predictors of poor treatment outcomes, and each was assigned a number of points proportional to its regression coefficient. These predictors and their points were: 1) history of taking second-line TB treatment (2 points), 2) resistance to any fluoroquinolones (3 points), and 3) smear did not convert from positive to negative at two months (4 points). We summed these points to calculate the risk score for each patient; three risk groups were defined: low risk (0 to 2 points), medium risk (3 to 5 points), and high risk (6 to 9 points). In the derivation group, poor treatment outcomes were reported for these three groups as 14%, 27%, and 71%, respectively. The area under the receiver operating characteristic curve for the point system in the derivation group was 0.69 (95% CI 0.60 to 0.77) and was similar to that in the validation group (0.67; 95% CI 0.56 to 0.78; p = 0.82).

Conclusion

History of second-line TB treatment, resistance to any fluoroquinolones, and smear non-conversion at two months can be used to estimate the risk of poor treatment outcome in patients with MDR-TB with a moderate degree of accuracy (AUROC = 0.69).

Klíčová slova:

Tuberculosis – Drug therapy – Extensively drug-resistant tuberculosis – China – Medical risk factors – Ethiopia – Sputum – Multi-drug-resistant tuberculosis


Zdroje

1. WHO. Global tuberculosis report 2018. Geneva: World Health Organization; 2018.

2. WHO. Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. Geneva, Switzerland World Health Organization; 2014.

3. Alene KA, Clements ACA, McBryde ES, Jaramillo E, Lonnroth K, Shaweno D, et al. Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis. The Journal of infection. 2018;77(5):357–67. doi: 10.1016/j.jinf.2018.07.007 30036607

4. WHO. Global tuberculosis report 2016. Geneva, Switzerland World Health Organization; 2016.

5. Alene KA, Viney K, McBryde ES, Tsegaye AT, Clements AC. Treatment outcomes in patients with multidrug-resistant tuberculosis in north-west Ethiopia. Tropical medicine & international health. 2017;22(3):351–62.

6. Alene KA, Yi H, Viney K, McBryde ES, Yang K, Bai L, et al. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis. 2017;17(1):573. doi: 10.1186/s12879-017-2662-8 28814276

7. WHO. Global tuberculosis report 2017. Geneva: World Health Organization, 2017.

8. Ettehad D, Schaaf HS, Seddon JA, Cooke GS, Ford N. Treatment outcomes for children with multidrug-resistant tuberculosis: a systematic review and meta-analysis. The Lancet infectious diseases. 2012;12(6):449–56. doi: 10.1016/S1473-3099(12)70033-6 22373593

9. Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, et al. Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. The Lancet infectious diseases. 2009;9(3):153–61. doi: 10.1016/S1473-3099(09)70041-6 19246019

10. Milanov V, Falzon D, Zamfirova M, Varleva T, Bachiyska E, Koleva A, et al. Factors associated with treatment success and death in cases with multidrug-resistant tuberculosis in Bulgaria, 2009–2010. International journal of mycobacteriology. 2015;4(2):131–7. doi: 10.1016/j.ijmyco.2015.03.005 26972881

11. Alene KA, Viney K, Gray DJ, McBryde ES, Wagnew M, Clements ACA. Mapping tuberculosis treatment outcomes in Ethiopia. BMC Infect Dis. 2019;19(1):474. doi: 10.1186/s12879-019-4099-8 31138129

12. Alene KA, Viney K, McBryde ES, Gray DJ, Melku M, Clements ACA. Risk factors for multidrug-resistant tuberculosis in northwest Ethiopia: A case-control study. Transbound Emerg Dis. 2019;66(4):1611–8. doi: 10.1111/tbed.13188 30924283

13. Alene KA, Viney K, Yi H, McBryde ES, Yang K, Bai L, et al. Comparison of the validity of smear and culture conversion as a prognostic marker of treatment outcome in patients with multidrug-resistant tuberculosis. PLoS One. 2018;13(5):e0197880. doi: 10.1371/journal.pone.0197880 29791488

14. WANG X-M, YIN S-H, DU J, DU M-L, WANG P-Y, Wu J, et al. Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: an optimized prediction model. Epidemiology & Infection. 2017;145(9):1805–14.

15. Lee K, Liu J-W, Chen Y-H, Chen Y-C, Tsai C-Y, Huang S-Y, et al. Development of a simple clinical risk score for early prediction of severe dengue in adult patients. PloS one. 2016;11(5):e0154772. doi: 10.1371/journal.pone.0154772 27138448

16. Chia YC, Gray SYW, Ching SM, Lim HM, Chinna K. Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study. BMJ open. 2015;5(5):e007324. doi: 10.1136/bmjopen-2014-007324 25991451

17. Rodondi N, Locatelli I, Aujesky D, Butler J, Vittinghoff E, Simonsick E, et al. Framingham risk score and alternatives for prediction of coronary heart disease in older adults. PLoS One. 2012;7(3):e34287. doi: 10.1371/journal.pone.0034287 22470551

18. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, et al. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care. Pediatric critical care medicine. 2013;14(7):673–81. doi: 10.1097/PCC.0b013e31829760cf 23863821

19. Wicki J, Perrier A, Perneger TV, Bounameaux H, Junod AF. Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. THROMBOSIS AND HAEMOSTASIS-STUTTGART-. 2000;84(4):548–52.

20. WB. Country Income Groups (World Bank Classification), Country and Lending Groups. 2011.

21. WHO. Use of high burden country lists for tuberculosis by WHO in the post-2015 era. Geneva, Switzerland: 2015.

22. Biruck Kebede BA, Anteneh Kassa, Wubaye Walelgne, Andargachew Kumsa, Addisalem Yilma, Lelisa Fekadu, Birru Shigut, Kasech Sintayehu, Solomon Hassen, Etsegenet, Endale Mengesha, Abebaw Kebede. Guidelines on Programmatic Management of Drug Resistant Tuberculosis in Ethiopia. In: Health FDROEMO, editor. Addis Ababa, Ethiopia 2013.

23. StataCorp. Stata Statistical Software: Release 15. College Station, TX: StataCorp LLC. 2017.

24. WHO. Definitions and reporting framework for tuberculosis– 2013 revision (updated 2014) Geneva, Switzerland World Health Organization 2013.

25. WHO. Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis. Geneva, Switzerland 2014.

26. Sullivan LM, Massaro JM, D’Agostino RB Sr. Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Statistics in medicine. 2004;23(10):1631–60. doi: 10.1002/sim.1742 15122742

27. Rassi A Jr, Rassi A, Little WC, Xavier SS, Rassi SG, Rassi AG, et al. Development and validation of a risk score for predicting death in Chagas’ heart disease. New England Journal of Medicine. 2006;355(8):799–808. doi: 10.1056/NEJMoa053241 16928995

28. Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. The Lancet Neurology. 2006;5(9):735–41. doi: 10.1016/S1474-4422(06)70537-3 16914401

29. Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB Sr, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. The Lancet. 2009;373(9665):739–45.

30. Acha J, Sweetland A, Guerra D, Chalco K, Castillo H, Palacios E. Psychosocial support groups for patients with multidrug-resistant tuberculosis: five years of experience. Global Public Health. 2007;2(4):404–17. doi: 10.1080/17441690701191610 19283636

31. van Hoorn R, Jaramillo E, Collins D, Gebhard A, van den Hof S. The effects of psycho-emotional and socio-economic support for tuberculosis patients on treatment adherence and treatment outcomes–a systematic review and meta-analysis. PloS one. 2016;11(4):e0154095. doi: 10.1371/journal.pone.0154095 27123848

32. Khanal S, Elsey H, King R, Baral SC, Bhatta BR, Newell JN. Development of a Patient-Centred, Psychosocial Support Intervention for Multi-Drug-Resistant Tuberculosis (MDR-TB) Care in Nepal. PloS one. 2017;12(1):e0167559. doi: 10.1371/journal.pone.0167559 28099475

33. Baral SC, Aryal Y, Bhattrai R, King R, Newell JN. The importance of providing counselling and financial support to patients receiving treatment for multi-drug resistant TB: mixed method qualitative and pilot intervention studies. BMC public health. 2014;14(1):46.

34. Atif M, Bashir A, Ahmad N, Fatima RK, Saba S, Scahill S. Predictors of unsuccessful interim treatment outcomes of multidrug resistant tuberculosis patients. BMC infectious diseases. 2017;17(1):655. doi: 10.1186/s12879-017-2746-5 28962599

35. Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM. Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PloS one. 2009;4(9):e6914. doi: 10.1371/journal.pone.0006914 19742330

36. Lv L, Li T, Xu K, Shi P, He B, Kong W, et al. Sputum bacteriology conversion and treatment outcome of patients with multidrug-resistant tuberculosis. Infection and Drug Resistance. 2018;11:147. doi: 10.2147/IDR.S153499 29416359

37. Kliiman K, Altraja A. Predictors of poor treatment outcome in multi-and extensively drug-resistant pulmonary TB. European Respiratory Journal. 2009;33(5):1085–94. doi: 10.1183/09031936.00155708 19164345

38. Falzon D, Gandhi N, Migliori GB, Sotgiu G, Cox H, Holtz TH, et al. Resistance to fluoroquinolones and second-line injectable drugs: impact on MDR-TB outcomes. European Respiratory Journal. 2012:erj01347-2012.

39. Sharma PC, Jain A, Jain S. Fluoroquinolone antibacterials: a review on chemistry, microbiology and therapeutic prospects. Acta Pol Pharm. 2009;66(6):587–604. 20050522

40. Noel GJ. A review of levofloxacin for the treatment of bacterial infections. Clinical Medicine Therapeutics. 2009;1:CMT. S28.

41. Jabeen K, Shakoor S, Hasan R. Fluoroquinolone-resistant tuberculosis: implications in settings with weak healthcare systems. International Journal of Infectious Diseases. 2015;32:118–23. doi: 10.1016/j.ijid.2015.01.006 25809767

42. WHO. WHO treatment guidelines for drug-resistant tuberculosis, 2016 update. Geneva, Switzerland: World Health Organization; 2016.

43. Redgrave LS, Sutton SB, Webber MA, Piddock LJ. Fluoroquinolone resistance: mechanisms, impact on bacteria, and role in evolutionary success. Trends in microbiology. 2014;22(8):438–45. doi: 10.1016/j.tim.2014.04.007 24842194

44. Shah NS, Wright A, Bai G-H, Barrera L, Boulahbal F, Martín-Casabona N, et al. Worldwide emergence of extensively drug-resistant tuberculosis. Emerging infectious diseases. 2007;13(3):380. doi: 10.3201/eid1303.061400 17552090

45. WHO. End-TB strategy Geneva, Switzerland World Health Organization 2015.

46. Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, et al. Comprehensive treatment of extensively drug-resistant tuberculosis. New England Journal of Medicine. 2008;359(6):563–74. doi: 10.1056/NEJMoa0800106 18687637

47. Organization WH. The use of bedaquiline in the treatment of multidrug-resistant tuberculosis: interim policy guidance: World Health Organization; 2013.


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