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. 2023 Aug 14;9(4):00135-2023.
doi: 10.1183/23120541.00135-2023. eCollection 2023 Jul.

Retreatment after loss to follow-up reduces mortality in patients with multidrug/rifampicin-resistant tuberculosis

Hongjo Choi  1 , Jeongha Mok  2 , Young Ae Kang  3 , Dawoon Jeong  4 , Hee-Yeon Kang  5 , Hee Jin Kim  6 , Hee-Sun Kim  7 , Doosoo Jeon  8
Affiliations

Retreatment after loss to follow-up reduces mortality in patients with multidrug/rifampicin-resistant tuberculosis

Hongjo Choi et al. ERJ Open Res. .

Abstract

Background: This study evaluated the risk factors of long-term mortality in patients with multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in South Korea who were lost to follow-up (LTFU).

Methods: This was a retrospective longitudinal follow-up study using an integrated database constructed by data linkage of the three national databases, which included 7226 cases of MDR/RR-TB notified between 2011 and 2017 in South Korea. Post-treatment outcomes of patients who were LTFU were compared with those of patients who achieved treatment success.

Results: Of the 7226 MDR/RR-TB cases, 730 (10.1%) were LTFU. During a median follow-up period of 4.2 years, 101 (13.8%) of the LTFU patients died: 25 deaths (3.4%) were TB related and 76 (10.4%) were non-TB related. In the LTFU group, the adjusted hazard ratio (aHR) of all-cause mortality (aHR 2.50, 95% CI 1.99-3.15, p<0.001), TB-related mortality (aHR 5.38, 95% CI 3.19-9.09, p<0.001) and non-TB-related mortality (HR 2.21, 95% CI 1.70-2.87, p<0.001) was significantly higher than that in the treatment success group. Independent risk factors for all-cause mortality in the LTFU group were age >55 years, fluoroquinolone resistance, cancer and no retreatment. In the LTFU patients who did not receive retreatment, the risk of non-TB-related mortality (aHR 5.00, 95% CI 1.53-16.37, p=0.008) and consequent all-cause mortality (aHR 2.18, 95% CI 1.08-4.40, p=0.030) was significantly higher than that of patients who received retreatment.

Conclusion: Non-TB-related mortality was the main cause of death and might be reduced by retreatment in LTFU patients with MDR/RR-TB.

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Conflict of interest statement

Conflict of interest: All authors have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the study population. Data are presented as n (%), unless otherwise indicated. MDR: multidrug resistant; RR: rifampicin resistant; TB: tuberculosis.
FIGURE 2
FIGURE 2
Kaplan–Meier survival curves comparing a) all-cause mortality, b) tuberculosis (TB)-related mortality and c) non-TB-related mortality according to retreatment in patients with multidrug/rifampicin-resistant TB who were lost to follow-up. Adjusted for age, gender, nationality, income, TB treatment history, lesion site, health institution, sputum smear result, drug susceptibility pattern, diabetes and cancer. HR: hazard ratio.
See this image and copyright information in PMC

References

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