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. 2020 Jan 15;15(1):e0227291.
doi: 10.1371/journal.pone.0227291. eCollection 2020.

Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia

Sílvia Brugueras  1   2   3 , Vinicio-Israel Molina  4 , Xavier Casas  4 , Yoel-Domingo González  4 , Nuria Forcada  4 , Dora Romero  4 , Anna Rodés  5 , Maria-Neus Altet  4 , José Maldonado  4 , Mario Martin-Sánchez  6 , Joan A Caylà  7 , Àngels Orcau  1   2   7 , Cristina Rius  1   2   3 , Joan-Pau Millet  1   2   4   7
Affiliations

Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia

Sílvia Brugueras et al. PLoS One. .

Abstract

Background: Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems.

Methods: This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI).

Results: There were 839 patients and 24 recurrences (2.9%), representing 0.49 per 100 person-years. The probability of a recurrence was 0.63% at 1 year of follow-up, 1.35% at 2 years, and 3.69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3.90; CI = 1.06-14.34 at age 35-45 years and aHR = 3.88; CI = 1.02-14.80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2.91; CI = 1.11-7.65).

Conclusions: Attention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.

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Conflict of interest statement

The authors have declared that no competing interests exist. The health center Serveis Clinics provided support in the form of salaries for some of the authors. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Kaplan-Meier curves of tuberculosis recurrence risk among all tuberculosis patients in the 2000–2016 cohort of Serveis Clínics, Catalonia.
Fig 2
Fig 2. Kaplan-Meier curves of tuberculosis recurrence risk among all tuberculosis patients in the 2000–2016 cohort of Serveis Clínics, Catalonia, according to age group (p value Log rank test = 0.043).
Fig 3
Fig 3. Kaplan-Meier curves of tuberculosis recurrence risk among all tuberculosis patients in the 2000–2016 cohort of Serveis Clínics, Catalonia, according to country of origin (p value Log rank test = 0.08).
Fig 4
Fig 4. Kaplan-Meier curves of tuberculosis recurrence risk among all tuberculosis patients in the 2000–2016 cohort of Serveis Clínics, Catalonia, according to smoking (p value Log rank test = 0.024).
Fig 5
Fig 5. Kaplan-Meier curves of tuberculosis recurrence risk among all tuberculosis patients in the 2000–2016 cohort of Serveis Clínics, Catalonia, according to prior TB episode (p value Log rank test = 0.025).
Fig 6
Fig 6. Kaplan-Meier curves of tuberculosis recurrence risk among all tuberculosis patients in the 2000–2016 cohort of Serveis Clínics, Catalonia, according to resistance (p value Log rank test = 0.075).
See this image and copyright information in PMC

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