Treatment outcomes and influencing factors in elderly patients with multidrug/rifampicin-resistant pulmonary tuberculosis: a national multicenter, retrospective cohort study

doi:10.19982/j.issn.1000-6621.20240215

Abstract

Abstract:

Objective: To analyze treatment outcomes and influencing factors of multidrug/rifampicin-resistant pulmonary tuberculosis (MDR/RR-PTB) in elderly patients. Methods: A national multicenter retrospective cohort study was conducted to include 475 elderly (≥60 years) MDR/RR-PTB patients who were admitted to six provincial tuberculosis hospitals from January 1, 2018 to December 31, 2020. Clinical characteristics of those patients were recorded and full course treatment was followed up. Multivariable logistic regression model was used to analyze factors affecting treatment outcomes. Results: Successful treatment rate of 475 elderly MDR/RR-PTB patients was 65.89% (313/475), cure rate and treatment completion rate were 50.74% (241/475) and 15.16% (72/475) respectively. Treatment failure rate was 13.05% (62/475), loss of follow-up rate was 17.05% (81/475) and mortality rate was 4.00% (19/475). Multivariable logistic regression analysis showed that 70-79 years old (OR=1.560, 95%CI: 1.001-2.431), ≥80 years old (OR=3.306, 95%CI: 1.370-7.974), lung cavities (OR=1.832, 95%CI: 1.195-2.808) were risk factors affecting MDR/RR-PTB treatment success in elderly patients. Inclusion of Bedaquiline in treatment regimen (OR=0.193, 95%CI: 0.044-0.841) was a protective factor for successful treatment. Conclusion: The treatment of elderly MDR/RR-PTB patients is complicated and difficult for which the successful treatment rate is low. Special attention should be paid to elderly patients aged ≥70 years and those with pulmonary cavities.

Key words: Tuberculosis, multidrug-resistant, Treatment outcome, Aged, Multicenter studies as topic

CLC Number:

R521

Ye Zhiteng, Ren Fei, Wang Hua, Yang Ming, Chen Yu, Chen Xiaohong, Wang Yun, Fan Lin. Treatment outcomes and influencing factors in elderly patients with multidrug/rifampicin-resistant pulmonary tuberculosis: a national multicenter, retrospective cohort study[J]. Chinese Journal of Antituberculosis, 2024, 46(9): 1023-1029. doi: 10.19982/j.issn.1000-6621.20240215

Figures/Tables 5

因素	β值	s $x ˉ$ 值	Wald χ²值	P值	OR(95%CI)值
60~69岁	-	-	-	-	1.000
70~79岁	0.445	0.226	3.866	0.049	1.560(1.001~2.431)
≥80岁	1.196	0.449	7.082	0.008	3.306(1.370~7.974)
使用贝达喹啉	-1.643	0.750	4.800	0.028	0.193(0.044~0.841)
出现肺部空洞	0.605	0.218	7.710	0.005	1.832(1.195~2.808)

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临床特征	例数	构成比(%)
性别
男性	379	79.79
女性	96	20.21
年龄组(岁)
60~69	342	72.00
70~79	111	23.37
≥80	22	4.63
合并糖尿病
有	85	17.89
无	390	82.11
合并肝脏疾病^a
有	6	1.26
无	469	98.74
合并免疫功能低下
有	16	3.37
无	459	96.63
合并肺外结核
有	63	13.26
无	412	86.74
肺部空洞
有	321	67.58
无	154	32.42
治疗类型
初治	76	16.00
复治	399	84.00

因素	例数	成功治疗(313例)	不良治疗转归(162例)	χ²值	P值
性别				0.032	0.858
男性	379	249(65.70)	130(34.30)
女性	96	64(66.67)	32(33.33)
年龄(岁)				10.235	0.006
60~69	342	238(69.59)	104(30.41)
70~79	111	66(59.46)	45(40.54)
≥80	22	9(40.91)	13(59.09)
合并糖尿病				1.015	0.314
是	85	60(70.59)	25(29.41)
否	390	253(64.87)	137(35.13)
合并肝脏疾病				0.155	0.694
是	6	3(50.00)	3(50.00)
否	469	310(66.10)	159(33.90)
免疫功能低下				0.060	0.806
是	16	11(68.75)	5(31.25)
否	459	302(65.80)	157(34.20)
合并肺外结核				0.180	0.671
是	63	43(68.25)	20(31.75)
否	412	270(65.53)	142(34.47)
使用贝达喹啉				5.907	0.015
是	21	19(90.48)	2(9.52)
否	454	294(64.76)	160(35.24)
使用利奈唑胺				1.138	0.286
是	175	110(62.86)	65(37.14)
否	300	203(67.67)	97(32.33)
使用氟喹诺酮类药物				1.160	0.281
是	399	267(66.92)	132(33.08)
否	76	46(60.53)	30(39.47)
使用环丝氨酸				0.494	0.482
是	315	211(66.98)	104(33.02)
否	160	102(63.75)	58(36.25)
使用氯法齐明				0.008	0.931
是	122	80(65.57)	42(34.43)
否	353	233(66.01)	120(33.99)
使用乙胺丁醇				0.899	0.343
是	190	130(68.42)	60(31.58)
否	285	183(64.21)	102(35.79)
使用吡嗪酰胺				3.317	0.069
是	305	210(68.85)	95(31.15)
否	170	103(60.59)	67(39.41)
使用注射类药物^a				0.029	0.865
是	243	161(66.26)	82(33.74)
否	232	152(65.52)	80(34.48)
治疗分类				0.081	0.776
初治	76	49(64.47)	27(35.53)
复治	399	264(66.17)	135(33.83)
肺部空洞				7.818	0.005
有	321	198(61.68)	123(38.32)
无	154	115(74.68)	39(25.32)
药物不良反应				0.160	0.689
有	170	114(67.06)	56(32.94)
无	305	199(65.25)	106(34.75)

变量	赋值
因变量
成功治疗	否=0;是=1
自变量
年龄(岁)	60~69=1;70~79=2;≥80=3
使用贝达喹啉	否=0;是=1
出现肺部空洞	否=0;是=1

抗结核药物	60~69岁 (342例)	70~79岁 (111例)	≥80岁 (22例)
贝达喹啉	19(5.56)	2(1.80)	2(9.09)
利奈唑胺	124(36.26)	44(39.64)	7(31.82)
氟喹诺酮类	287(83.92)	96(86.49)	16(72.73)
环丝氨酸	230(67.25)	72(64.86)	13(59.09)
氯法齐明	87(25.44)	30(27.03)	5(22.73)
乙胺丁醇	137(40.06)	44(39.64)	9(40.91)
吡嗪酰胺	226(66.08)	67(60.36)	12(54.55)
注射类药物	202(59.06)	39(35.14)	2(9.09)