Low BMI increases all-cause mortality rates in patients with drug-resistant TB
OBJECTIVE: To determine rates of and factors associated with all-cause mortality among patients with DR-TB who were LTFU.
METHODS: Retrospective cohort study of adult patients with DR-TB in Georgia who initiated second-line TB treatment during 2011–2014 and were LTFU. Survival analyses were used to estimate all-cause mortality rates and adjusted hazard ratios (aHR).
RESULTS: During 2011–2014, 2,437 second-line treatment episodes occurred and 695 patients were LTFU. Among 695 LTFU patients, 143 (21%) died during 2,686 person-years (PY) post-LTFU (all-cause mortality rate 5.1%, 95% CI 4.3–6.0 per 100 PY). In multivariable analysis, low weight (BMI < 18.5 kg/m2) at treatment initiation (aHR 3.2, 95% CI 2.2–4.7), return to treatment after LTFU (aHR 3.1, 95% CI 2.2–4.4), <12 months of treatment (aHR 2.4, 95% CI 1.4–4.1) and a pre-LTFU positive culture (aHR 3.3, 95% CI 2.2–4.9) were associated with all-cause mortality.
CONCLUSION: High all-cause mortality occurred among patients with DR-TB after LTFU despite a low HIV prevalence. Providing additional assistance for patients during DR-TB treatment to prevent LTFU and use of new and shorter treatment regimens may reduce mortality among LTFU.
Keywords: TB mortality; drug-resistant tuberculosis; loss to follow-up; tuberculosis
Document Type: Research Article
Affiliations: 1: National Center for Disease Control and Public Health, Tbilisi, Georgia 2: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 3: Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 4: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 5: Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA 6: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia 7: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
Publication date: April 1, 2022
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