Which factors increase risk of death in drug-resistant TB?

Patient-related factors, such as sex, comorbidities, and medical history, affect the risk of early mortality in drug-resistant tuberculosis (DR-TB), reports a recent meta-analysis.

Drawing from the databases of PubMed, CINAHL, Embase, Scopus, Web of Science, and Google, the researchers retrieved 49 eligible studies and looked at potential predictors and indicators of mortality in DR-TB patients.

Pooled analysis found older age to be a significant predictor of mortality (hazard ratio [HR], 2.13, 95 percent confidence interval [CI], 1.64–2.62), such that each additional year increment corresponded to a 1-percent increase in such risk (HR, 1.01, 95 percent CI, 1.00–1.03). Being male was also associated with mortality (HR, 1.25, 95 percent CI, 1.08–1.41).

Clinical factors were also significantly associated with death, in particular undernutrition (HR, 1.62, 95 percent CI, 1.28–1.97).

Similarly, having any type of comorbidity increased the risk of mortality by over 90 percent (HR, 1.92, 95 percent CI, 1.50–2.33). Such an effect was driven by a host of conditions, including diabetes, coinfection with HIV, and extensively drug-resistant TB.

Patient who had prior TB infections were at risk of mortality, too, as did those who had previously taken second-line anti-TB treatments.

“The presence of different comorbidities and developing clinical complications worsen the treatment outcome in addition to the gender and age differences. Special considerations and personalized treatment and follow-up of patients with other comorbidities, the elder ones, those who develop clinical complications, and those with previous anti-TB treatments could be essential to have a good prognosis,” the researchers said.