Analysis of influencing factors of treatment outcomes of retreated multidrug-resistant/rifampicin-resistant pulmonary tuberculosis patients: a national multicenter retrospective cohort study

doi:10.19982/j.issn.1000-6621.20240088

Abstract

Abstract:

Objective: To analyze the influencing factors of treatment outcomes of retreated multidrug/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) patients. Methods: A multicenter retrospective cohort study was conducted to include 2291 MDR/RR-PTB patients admitted to six provincial tuberculosis designated hospitals from January 1, 2018 to December 31, 2020. Treatment information of those patients was followed up, clinical characteristics were recorded. Univariable and multivariable logistic regression were used to analyze the influencing factors of treatment outcomes of retreated MDR/RR-PTB patients. Results: Cure rate of 2291 patients was 56.44% (1293/2291), completion rate was 16.28% (373/2291), thus treatment success rate was 72.72% (1666/2291). Treatment failure rate was 11.39% (261/2291), mortality rate was 1.44% (33/2291), and loss of follow-up rate was 14.45% (331/2291). The analysis showed that combined with diabetes (OR(95%CI)=1.739 (1.315-2.301)), combined with liver disease (OR(95%CI)=2.230 (1.213-4.099)) and pulmonary cavity (OR(95%CI)=1.531 (1.244-1.885)) were risk factors for treatment failure, while regimen containing bedaquiline (OR(95%CI)=0.163 (0.097-0.274)) and gender being female (OR(95%CI)=0.713 (0.571-0.890)) were protective factors. Conclusion: The classification and treatment regime of retreated MDR/RR-PTB patients are complicated, and treatment outcomes of different types of retreated patients differentiated. Adverse and favorable factors affecting treatment outcomes should be fully identified to perform individualized treatment on patients.

Key words: Tuberculosis, multidrug-resistant, Treatment outcome, Factor analysis, statistical, Multicenter studies as topic, Cohort studies

CLC Number:

R521

Ye Zhiteng, Ren Fei, Wang Hua, Yang Ming, Chen Yu, Chen Xiaohong, Wang Yun, Fan Lin. Analysis of influencing factors of treatment outcomes of retreated multidrug-resistant/rifampicin-resistant pulmonary tuberculosis patients: a national multicenter retrospective cohort study[J]. Chinese Journal of Antituberculosis, 2024, 46(7): 778-784. doi: 10.19982/j.issn.1000-6621.20240088

Figures/Tables 4

变量	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
女性	―0.339	0.113	8.956	0.003	0.713(0.571~0.890)
合并糖尿病	0.554	0.143	15.021	<0.001	1.739(1.315~2.301)
合并肝脏疾病	0.802	0.311	6.663	0.010	2.230(1.213~4.099)
使用贝达喹啉	―1.815	0.265	46.833	<0.001	0.163(0.097~0.274)
出现肺部空洞	0.426	0.106	16.104	<0.001	1.531(1.244~1.885)

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因素	例数	成功治疗 (1666例)	未成功治疗 (625例)	χ²值	P值
性别				9.894	0.002
男性	1684	1195(70.96)	489(29.04)
女性	607	471(77.59)	136(22.41)
合并糖尿病				14.093	0.001
是	259	163(62.93)	96(37.07)
否	2032	1503(73.97)	529(26.03)
合并肝脏疾病^a				4.624	0.032
是	49	29(59.18)	20(40.82)
否	2242	1637(73.02)	605(26.98)
免疫功能低下				0.151	0.698
是	56	42(75.00)	14(25.00)
否	2235	1624(72.66)	611(27.34)
并发肺外结核				0.207	0.649
是	484	348(71.90)	136(28.10)
否	1807	1318(72.94)	489(27.06)
复治类型				53.090	0.001
标准初治治疗失败	668	521(77.99)	147(22.01)
标准初治治疗复发	597	453(75.88)	144(24.12)
反复抗结核治疗>2年	580	360(62.07)	220(37.93)
复治治疗失败或复发	236	188(79.66)	48(20.34)
耐多药方案治疗失败或复发	210	144(68.57)	66(31.43)
使用贝达喹啉				58.487	0.001
是	248	231(93.15)	17(6.85)
否	2043	1435(70.24)	608(29.76)
使用利奈唑胺				10.414	0.001
是	889	680(76.49)	209(23.51)
否	1402	986(70.33)	416(29.67)
使用氟喹诺酮类药物				0.258	0.611
是	1865	1352(72.49)	513(27.51)
否	426	314(73.71)	112(26.29)
出现肺部空洞				16.233	0.001
有	1577	1107(70.20)	470(29.80)
无	714	559(78.29)	155(21.71)

变量	赋值
因变量
成功治疗	否=0;是=1
自变量
性别	男性=1;女性=2
合并糖尿病	否=0;是=1
合并肝脏疾病	否=0;是=1
使用贝达喹啉	否=0;是=1
使用利奈唑胺	否=0;是=1
出现肺部空洞	否=0;是=1

复治类型	例数	准广泛/广泛耐药肺结核患者	非准广泛/广泛耐药肺结核患者	χ²值^a	P值^a
耐多药方案治疗失败或复发	210	143(68.10)	67(31.90)	-	-
标准初治治疗失败	668	167(25.00)	501(75.00)	129.909	<0.001
标准初治治疗复发	597	155(25.96)	442(74.04)	118.404	<0.001
反复抗结核治疗>2年	580	284(48.97)	296(51.03)	22.717	<0.001
复治治疗失败或复发	236	113(47.88)	123(52.12)	18.568	<0.001