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: 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:

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


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