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Rupani MP. Silicosis as a predictor of tuberculosis mortality and treatment failure and need for incorporation in differentiated TB care models in India. Arch Public Health 2023; 81:173. [PMID: 37752612 PMCID: PMC10521559 DOI: 10.1186/s13690-023-01189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Differentiated tuberculosis (TB) care is an approach to improve treatment outcomes by tailoring TB management to the particular needs of patient groups based on their risk profile and comorbidities. In silicosis-prone areas, the coexistence of TB and silicosis may exacerbate treatment outcomes. The objective of the study was to determine predictors of TB-related mortality, treatment failure, and loss to follow-up in a silicosis-prone region of western India. METHODS A retrospective cohort was conducted among 2748 people with TB registered between January 2006 and February 2022 in Khambhat, a silicosis-prone block in western India. Death, treatment failure, and loss to follow up were the outcome variables. The significant predictors of each outcome variable were determined using multivariable logistic regression and reported as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS In the cohort of 2,748 people with TB, 5% presented with silicosis, 11% succumbed to the disease, 5% were lost to follow-up during treatment, and 2% encountered treatment failure upon completion of therapy. On multivariable logistic regression, concomitant silicosis [aOR 2.3 (95% CI 1.5-3.5)], advancing age [aOR 1.03 (95% CI 1.02-1.04)], male gender [aOR 1.4 (95% 1.1-1.9)], human immunodeficiency virus (HIV) positive [aOR 2.2 (95% 1.02-4.6)], and previous TB treatment [aOR 1.5 (95% CI 1.1-1.9)] significantly predicted mortality among people with TB. Concomitant silicosis [aOR 3 (95% CI 1.4-6.5)], previous TB treatment [aOR 3 (95% CI 2-6)], and multi-drug resistant TB [aOR 18 (95% CI 8-41)] were the significant predictors of treatment failure on adjusted analysis. Advancing age [aOR 1.012 (1.001-1.023)], diabetes [aOR 0.6 (0.4-0.8)], and multi-drug resistance [aOR 6 (95% CI 3-12)] significantly predicted loss to follow-up after adjusting for confounders. CONCLUSIONS Controlling silicosis might decrease TB mortality and treatment failure in silicosis-prone regions. The coexistence of HIV and silicosis may point to an increase in TB deaths in silicosis-prone areas. Silicosis should now be acknowledged as a major comorbidity of TB and should be included as one of the key risk factors in the differentiated TB care approach. Primary care physicians should have a high clinical suspicion for silicosis among individuals diagnosed with TB in silicosis-prone blocks.
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Affiliation(s)
- Mihir P Rupani
- Clinical Epidemiology (Division of Health Sciences), ICMR - National Institute of Occupational Health (NIOH), Indian Council of Medical Research, Meghaninagar , Ahmedabad City, Gujarat, 380016, India.
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Li D, Tang SY, Lei S, Xie HB, Li LQ. A nomogram for predicting mortality of patients initially diagnosed with primary pulmonary tuberculosis in Hunan province, China: a retrospective study. Front Cell Infect Microbiol 2023; 13:1179369. [PMID: 37333854 PMCID: PMC10272565 DOI: 10.3389/fcimb.2023.1179369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Objective According to the Global Tuberculosis Report for three consecutive years, tuberculosis (TB) is the second leading infectious killer. Primary pulmonary tuberculosis (PTB) leads to the highest mortality among TB diseases. Regretfully, no previous studies targeted the PTB of a specific type or in a specific course, so models established in previous studies cannot be accurately feasible for clinical treatments. This study aimed to construct a nomogram prognostic model to quickly recognize death-related risk factors in patients initially diagnosed with PTB to intervene and treat high-risk patients as early as possible in the clinic to reduce mortality. Methods We retrospectively analyzed the clinical data of 1,809 in-hospital patients initially diagnosed with primary PTB at Hunan Chest Hospital from January 1, 2019, to December 31, 2019. Binary logistic regression analysis was used to identify the risk factors. A nomogram prognostic model for mortality prediction was constructed using R software and was validated using a validation set. Results Univariate and multivariate logistic regression analyses revealed that drinking, hepatitis B virus (HBV), body mass index (BMI), age, albumin (ALB), and hemoglobin (Hb) were six independent predictors of death in in-hospital patients initially diagnosed with primary PTB. Based on these predictors, a nomogram prognostic model was established with high prediction accuracy, of which the area under the curve (AUC) was 0.881 (95% confidence interval [Cl]: 0.777-0.847), the sensitivity was 84.7%, and the specificity was 77.7%.Internal and external validations confirmed that the constructed model fit the real situation well. Conclusion The constructed nomogram prognostic model can recognize risk factors and accurately predict the mortality of patients initially diagnosed with primary PTB. This is expected to guide early clinical intervention and treatment for high-risk patients.
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Affiliation(s)
- Dan Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
- College of Applied Technology, Hunan Open University, Changsha, Hunan, China
| | - Si-Yuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Sheng Lei
- Interventional Radiology Center, Hunan Chest Hospital, Changsha, Hunan, China
| | - He-Bin Xie
- Department of Drug Clinical Trial Institutions, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, China
| | - Lin-Qi Li
- School of Public Health, University of South China, Hengyang, China
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Araújo-Pereira M, Nogueira BMF, Spener-Gomes R, Carvalho ACC, Sant'Anna FM, Figueiredo MC, Turner MM, Kritski AL, Cordeiro-Santos M, Rolla VC, Sterling TR, Andrade BB. Anemia and anti-tuberculosis treatment outcome in persons with pulmonary tuberculosis: A multi-center prospective cohort study. J Infect Public Health 2023; 16:974-980. [PMID: 37121049 PMCID: PMC10194045 DOI: 10.1016/j.jiph.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a major plague of humanity. People with TB (PWTB) are commonly anemic. Here, we assessed whether the severity of anemia in PWTB prior to anti-TB treatment (ATT) was a risk factor for an unfavorable outcome. METHODS Patients ≥ 18 years old with culture-confirmed drug-susceptible pulmonary TB enrolled between 2015 and 2019 in a multi-center Brazilian cohort were followed for up to 24 months and classified according to anemia severity (mild, moderate, and severe), based on hemoglobin levels. A multinomial logistic regression model was employed to assess whether anemia was associated with unfavorable outcome (death, failure, loss to follow-up, regimen modification or relapse), compared to treatment success (cure or treatment completion). RESULTS Among 786 participants who met inclusion criteria, 441 (56 %) were anemic at baseline. Patients with moderate/severe anemia were more HIV-seropositive, as well as more symptomatic and had higher frequencies of unfavorable outcomes compared to the other groups. Moderate/severe anemia (adjusted OR [aOR]: 7.80, 95 %CI:1.34-45.4, p = 0.022) was associated with death independent of sex, age, BMI, HIV and glycemic status. CONCLUSION Moderate/severe anemia prior to ATT was a significant risk factor for death. Such patients should be closely monitored given the high risk of unfavorable ATT outcomes.
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Affiliation(s)
- Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Curso de Medicina, Universidade FTC, Salvador, Brazil.
| | - Betânia M F Nogueira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - Renata Spener-Gomes
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil; Universidade Federal do Amazonas, Manaus, Brazil
| | - Anna C C Carvalho
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Flávia Marinho Sant'Anna
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Megan M Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil; Universidade Nilton Lins, Manaus, Brazil
| | - Valeria C Rolla
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Curso de Medicina, Universidade FTC, Salvador, Brazil.
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Penjor K, Kuenzang, Tshokey T, Wangdi K. The trend of tuberculosis case notification and predictors of unsuccessful treatment outcomes in Samdrup Jongkhar district, Bhutan: A fourteen-year retrospective study. Heliyon 2021; 7:e06573. [PMID: 33855240 PMCID: PMC8027770 DOI: 10.1016/j.heliyon.2021.e06573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 03/17/2021] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) continues to be an important public health issue in Bhutan. This study aims to describe the trend of tuberculosis and investigate factors associated with a unsuccessful treatment outcome in Samdrup Jongkhar District in Bhutan. A fourteen-year (2004–2017) case records in two TB centres of Dewathang and Samdrup Jongkhar Hospitals were reviewed and analyzed to examine trends in case notification and treatment outcomes. Univariable and multivariable logistic regression analysis was undertaken to identify covariates of unsuccessful TB treatment. Of the total of 820 TB cases registered in surveillance record, 729 cases were analysed. Males made up 53.8% (397) of total cases and the median age was 29 years (range: 2–87 years). A gradual downward trend in TB case notification was noticed in the district with overall case notification rate of 139/100,000 during the study period. The annual treatment success rate was over 90% except for years 2013–2015 with overall treatment success rate for the study period at 93%. A re-treatment TB patient, sputum-positive at the second month of treatment and being of Indian nationality were significant correlates of unsuccessful treatment outcomes. The overall TB inclidence has declined and TB treatment success rate was above WHO recommended 90% in Samdrup Jongkhar District during the study period. A special attention should be paid to the poor treatment outcome predictors including re-treatment cases and failed sputum conversion at the second month of treatment.
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Affiliation(s)
- Kinley Penjor
- Dewathang Military Hospital, Samdrup Jongkhar, Department of Medical Services, Ministry of Health, Bhutan.,Vector-borne Diseases Control Program, Department of Public Health, Ministry of Health, Gelephu, Bhutan
| | - Kuenzang
- Dewathang Military Hospital, Samdrup Jongkhar, Department of Medical Services, Ministry of Health, Bhutan
| | - Tshokey Tshokey
- Department of Laboratory Services, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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