Factors Associated with Mortality among Multidrug Resistant Tuberculosis MDR/RR-TB Patients in Democratic Republic of Congo

Abstract

Background: Tuberculosis remains a very common infectious disease in Democratic Republic of Congo (DRC). The resistance to drugs worsens the prognosis and the outcome of patients affected tuberculosis and increase their mortality. Objective: To identify factors associated with death among Multidrugs resistant tuberculosis (MDR/RR TB) patients referred to the referential hospital, Centre d'Excellence Damien (CEDA). Materials and Methods: A retrospective cohort study of patients attending health care to the Center CEDA, a referral center for management of MDR/RR-TB in DR Congo. This study included all MDR/RR-TB patients referred from February 1st, 2015 to February 29th, 2017. A multivariate COX regression was performed to identify factors associated with mortality in the target population. Kaplan Meier method described the survival of patients and the comparison of curves was performed by the test of log Rank. Results: 199 patients were included in our study. Male gender was predominant with a sex ratio of 1.3. The mean age of patients was 35.8 ± 13.9 years. Among them, 18 (15.1%) were died. The major complications were Chronicles pulmonary Heart failure (p = 0.035), Chronic respiratory insufficiency (p = 0.004), depression (p = 0.044), undernutrition (p = 0.033), alcohol addiction (p = 0.006) and high smoking (p = 0.019). In multivariated analysis, factors associated to the death were alcohol addiction (HRa = 12.64, 95% CI 2.36 -14.55, p = 0.003), asthenia (HRa = 4.75, 95% CI 1.56 -14.50, p < 0.001), pulmonary consolidation (HRa = 10.01 95% CI 2.34 -12.86, p = 0.02), some chest X-ray abnormalities such as signs of pulmonary

Poor treatment outcome and its predictors among drug-resistant tuberculosis patients in Ethiopia: A systematic review and meta-analysis

“…In the current study, about 15.13% of patients with MDR/RR-TB died during their anti-TB treatment follow-up. Comparable mortality rates were also reported from different countries; Pakistan (Javaid et al, 2018;Khan et al, 2015), South Africa (Hirasen et al, 2018), Democratic Republic of Congo (Kashongwe et al, 2017), Tajikistan (Makhmudova et al, 2019), Malaysia (Mohd Shariff et al, 2016, India (Nair et al, 2017) and Taiwan (Lin et al, 2019). Relatively lower mortality rates were reported from Kenya (Kiprotich et al, 2014), Sudan (Ali et al, 2019), Egypt (Gadallah et al, 2016), Brazil (Gayoso et al, 2018), USA (Kurbatova et al, 2012), Lativa (Leimane et al, 2005), Tanzania (Mollel and Chilongola, 2017), and China (Zhang et al, 2018).…”

Incidence and predictors of mortality among persons receiving second-line tuberculosis treatment in sub-Saharan Africa: A meta-analysis of 43 cohort studies

“…From among the 43 studies that were included, a total of 31,525 persons receiving SLD were followed-up and 4,976 of them encountered the incidence of mortality. The study participants for four of these studies were children [32][33][34][35]; for 20 of the studies were adults [23,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]; and for 19 of the studies were both adults and children [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73]. Methodological design for nine of the studies was prospective cohort [23, 39, 42-46, 50, 63] while it was retrospective cohort for 34 of the remaining studies [32-38, 40, 41, 47-49, 51-62, 64-73].…”

“…from the central region [42,64]; one of the study was from the western region [59]; and the remaining one study was from multi-sites in different SSA regions [50]. A total of 23 studies out of the 43 publications identified had reported the predictors of mortality among the persons receiving SLD therapy [23, 32, 34, 35, 37-41, 44, 47, 49, 52, 54, 55, 57, 59-61, 64, 67, 69, 71].…”

“…Nineteen (19) of these studies reported HIV-coinfection and other comorbidities (i.e., diabetes mellitus, myocardial infractions, hypertension, congestive heart failure, asthma, epilepsy, depression, chronic pulmonary insufficiency and pulmonary fibrosis) [32, 34, 35, 37-41, 44, 49, 52, 54, 55, 59-61, 64, 67, 71] while ten of the studies reported diagnoses of clinical conditions such as anemia, underweight (BMI < 18.5 Kg/m2), pneumothorax, pneumonia, hemoptysis, opportunistic infections, cavitary changes and nutritional problems [23,32,34,44,47,51,52,57,64,69] as the key predictors of all-cause mortality. Besides, three of the studies specific to each feature had reported resistance to SLD [54,69,71]; male sex [32,49,67]; and excessive substance use [61,64,69] as the predictors of all-cause mortality. Moreover, two of the studies reported delays (i.e., more than a month) in initiating SLD therapy [59,61]; encounters of adverse drug events (ADEs) [40,41], and extrapulmonary involvement [34,41] as the predictors of the mortality outcome.…”

Factors associated with mortality in HIV‐TB co‐infected patients during and after the course of TB treatment in high‐burden settings, Mumbai, India: A cohort analysis

“…Furthermore, authors have also found that most TB related deaths in PLHIV were within the first 3 months of diagnosis of HIV [12]. Drug resistance is another important factor contributing to mortality in HIV‐TB co‐infected patients [13, 14]. It has been reported that 1 month and 1 year mortality was higher in those with drug resistance, and mortality increased with the degree of resistance (higher in extensive drug resistance [XDR] compared with multidrug resistant [MDR]) [15].…”