Survival analysis of patients with tuberculosis in Erbil, Iraqi Kurdistan region

Balaky, Salah Tofik Jalal; Mawlood, Ahang Hasan; Shabila, Nazar P.

doi:10.1186/s12879-019-4544-8

Cited by 17 publications

(22 citation statements)

References 29 publications

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“…The likelihood of dying for patients with extrapulmonary TB was 3 times higher than for patients with pulmonary positive. Higher proportions of death among extra-pulmonary TB patients were reported in studies from Ethiopia, 15 Iraq, 34 and Cameron. 35 This noticeable rate of mortality might be due to insufficient information about the extrapulmonary TB symptoms and the lack of access to medical facilities.…”

Section: Discussionmentioning

confidence: 75%

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<p>Modeling the Survival of Tuberculosis Patients in Eastern Zone of Tigray Regional State</p>

Geleso¹

2020

RMHP

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Background: Tuberculosis (TB) is still a public health problem and amongst the top ten leading causes of death. The aim of this paper was to identify the factors that significantly affect the survival of tuberculosis patients. Methods: A retrospective cohort study was carried out in Adigrat General and Wukro hospitals, Eastern Zone of Tigray region, Ethiopia. Data for this study were obtained from medical records of all TB cases registered from September 2016 to August 2017 in the two hospitals. Log-rank test and Kaplan-Meier plot were used to evaluate the survival pattern of TB patients. A multivariable Cox proportional regression model was employed to identify the predictors of mortality. Factors with a P-value smaller than 0.05 were taken as statistically significant facilitators of TB death. Results: Of the 397 patients studied over the specified period, 23 (5.8%) had died. A statistically significant survival difference was observed among gender, residence, HIV status, treatment category, and age category of patients. In multivariable cox regression, lower survival rates were observed among patients aged ≥45 years (HR = 5.315, 95% CI: 1.231-22.959), relapse cases (HR = 4.069, 95% CI: 1.636-10.119), patients with extrapulmonary TB (HR = 3.054, 95% CI: 1.044-8.940), patients from rural areas (HR = 2.834, 95% CI: 1.161-6.916), patients with a bodyweight of ≤50 kg and HIV-positive patients. Conclusion: Based on the survival experience of TB patients, advancing age, extrapulmonary TB infection, living in rural residence, lower bodyweight at beginning of treatment, HIV coinfection, and being a retreatment patient were predictors of mortality. To achieve the "End TB Strategy" goal of zero death, proper targeting of care to these vulnerable groups should be advised.

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Section: Discussionmentioning

confidence: 75%

“…36 Extrapulmonary TB is complicated and difficult to diagnose, and it requires a high clinical diagnostic measure. 34 Time until diagnosis was significantly associated with morbidity and mortality. 37…”

Section: Discussionmentioning

confidence: 99%

<p>Modeling the Survival of Tuberculosis Patients in Eastern Zone of Tigray Regional State</p>

Geleso¹

2020

RMHP

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“…Studies in Iraqi Kurdistan showed that no significant difference between male and female patients’ in terms of mortality. Multivariate analysis showed that gender factors in our study did not affect the survival of TB patients [ 8 , 22 ]. The difference in these findings requires further studies with regards to factors responsible for the difference in survival between males and females.…”

Section: Discussionmentioning

confidence: 99%

“…Using retrospective research methods, we reviewed the records of 337 patients diagnosed and treated for TB at National Leprosy and Tuberculosis Control Program in Monrovia, Liberia in 2015 [ 8 ]. Chest X-ray, GeneXpert MTB/RIF and smear microscopy are used to diagnose tuberculosis patients.…”

Section: Methodsmentioning

confidence: 99%

Survival analysis of patients with tuberculosis and risk factors for multidrug-resistant tuberculosis in Monrovia, Liberia

et al. 2021

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We reviewed the records of 337 confirmed cases of tuberculosis patients in Monrovia, the capital of Liberia, 2015. The risk factors affecting the survival and multidrug-resistance of tuberculosis patients were examined. Kaplan-Meier analysis and the log-rank test were used to assess the differences in survival among the patients, while Cox regression model was used for multivariate analysis. The qualitative data was tested with chi-square test in the single factor analysis of multidrug-resistant TB. Multivariate analysis was performed using binary logistic regression analysis. The significance level for all the tests were set at 0.05. The mean period of the follow-up of patients was 10 months. In the 337 patients, 33 (9.8%) died, the 21-month survival rate was 90.2%. The results of multivariate Cox regression analysis show that overcrowding (HR = 7.942, 95% CI 3.258–19.356), former smoking (HR = 3.773, 95% CI 1.601–8.889), current smoking (HR = 3.546, 95% CI 1.195–10.521), multidrug-resistance tuberculosis (HR = 4.632, 95% CI 1.913–11.217) were risk factors for death during anti-tuberculosis treatment in TB patients in Liberia. The results of binary logistic regression analysis show that extra-pulmonary (OR = 2.032, 95% CI 1.133–3.644), family history of TB (OR = 2.387, 95% CI 1.186–4.807) and current smoking (OR = 3.436, 95% CI 1.681–7.027) were risk factors for multidrug-resistant tuberculosis. These results can provide insights on local tuberculosis early intervention, increase public health awareness, and strengthen the control of factors that may affect the survival and multidrug-resistance of tuberculosis patients.

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“…Researches done in different countries, Kenya included, utilizing these TB data have explored the survival arm of the data using Cox model. Examples include (6)(7)(8)(9)(10)(11)(12), all which did not include sputum smear results in their model. Studies by (8,13) considered only baseline sputum smear measures while (14) derived a variable on whether a patient had follow up sputum or not.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal-Survival Models for Case-Based Tuberculosis Progression

Kiplimo

Kosgei

Mwangi

et al. 2021

Front. Public Health

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Introduction: Tuberculosis (TB) disease continues to be responsible for a high global burden with an estimated 10 million people falling ill each year and an estimated 1.45 million deaths. Widely carried out analyses to utilize routine data coming from this disease, and well-established in literature, have paid attention to time-to-event with sputum smear results being considered only at baseline or even ignored. Also, logistic regression models have been used to demonstrate importance of sputum smear results in patient outcomes. A feature presented by this disease, however, is that each individual patient is usually followed over a period of time with sputum smear results being documented at different points of the treatment curve. This provides both repeated measures and survival times, which may require a joint modeling approach. This study aimed to investigate the association between sputum smear results and the risk of experiencing unfavorable outcome among TB patients and dynamically predict survival probabilities.Method: A joint model for longitudinal and time-to-event data was used to analyze longitudinally measured smear test results with time to experiencing unfavorable outcome for TB patients. A generalized linear mixed-effects model was specified for the longitudinal submodel and cox proportional hazards model for the time-to-event submodel with baseline hazard approximated using penalized B-splines. The two submodels were then assumed to be related via the current value association structure. Bayesian approach was used to approximate parameter estimates using Markov Chain Monte Carlo (MCMC) algorithm. The obtained joint model was used to predict the subject's future risk of survival based on sputum smear results trajectories. Data were sourced from routinely collected TB data stored at National TB Program database.Results: The average baseline age was 35 (SD: 15). Female TB patients constituted 36.42%. Patients with previous history of TB treatment constituted 6.38% (event: 15.25%; no event: 5.29%). TB/HIV co-infection was at 31.23% (event: 47.87%; no event: 29.20%). The association parameter 1.03 (CI[1.03,1.04]) was found to be positive and significantly different from zero, interpreted as follows: The estimate of the association parameter α = 1.033 denoted the log hazard ratio for a unit increase in the log odds of having smear positive results. HIV status (negative) 0.47 (CI [0.46,49]) and history of TB treatment (previously treated) (2.52 CI [2.41,2.63]), sex (female) (0.82 CI [0.78,0.84]), and body mass index (BMI) categories (severe malnutrition being reference) were shown to be statistically significant.Conclusion: Sputum smear result is important in estimating the risk to unfavorable outcome among TB patients. Men, previously treated, TB/HIV co-infected and severely malnourished TB patients are at higher risk of unfavorable outcomes.

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Survival analysis of patients with tuberculosis in Erbil, Iraqi Kurdistan region

Cited by 17 publications

References 29 publications

<p>Modeling the Survival of Tuberculosis Patients in Eastern Zone of Tigray Regional State</p>

<p>Modeling the Survival of Tuberculosis Patients in Eastern Zone of Tigray Regional State</p>

Survival analysis of patients with tuberculosis and risk factors for multidrug-resistant tuberculosis in Monrovia, Liberia

Longitudinal-Survival Models for Case-Based Tuberculosis Progression

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