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Original Article
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- Timing and predictors of death during treatment in patients with multidrug/rifampin-resistant tuberculosis in South Korea
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1Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
2Division of Health Policy and Management, Korea University College of Health Science, Seoul, Korea
3Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
5Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Corresponding author: Doosoo Jeon ,Tel: +82-55-360-2120, Fax: +82-55-360-1757, Email: sooli10@hanmail.net
- Received: January 29, 2024; Revised: March 13, 2024 Accepted: March 28, 2024.
- Abstract
- Background/Aims
This study aimed to investigate the timing and predictors of death during treatment among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB) in South Korea.
Methods
This was a retrospective cohort study that included MDR/RR-TB cases notified between 2011 and 2017 in South Korea.
Results
Among 7,226 MDR/RR-TB cases, 699 (9.7%) died at a median of 167 days (IQR 51–358 d) from the initiation of MDR-TB treatment. The cumulative proportion of all-cause death was 35.5% at 90 days and 52.8% at 180 days from treatment initiation. TB-related deaths occurred at a median of 133 days (IQR 32–366 d), which was significantly earlier than the median of 184 days (IQR 68–356 d) for non-TB-related deaths (p = 0.002). In a multivariate analysis, older age was the factor most strongly associated with death, with those aged ≥ 75 years being 68 times more likely to die (aHR 68.11, 95% CI 21.75–213.26), compared those aged ≤ 24 years. In addition, male sex, comorbidities (cancer, human immunodeficiency virus, and end stage renal disease), the lowest household income class, and TB-specific factors (previous history of TB treatment, smear positivity, and fluoroquinolone resistance) were identified as independent predictors of all-cause death.
Conclusions
This nationwide study highlights increased deaths during the intensive phase and identifies high-risk groups including older people and those with comorbidities or socioeconomic vulnerabilities. An integrated and comprehensive strategy is required to reduce mortality in patients with MDR/RR-TB, particularly focusing on the early stages of treatment and target populations.
Keywords :Tuberculosis; Multidrug resistance; Death; Risk factors; South Korea
