Risk factors associated with morbidity and unfavorable treatment outcome in drug-resistant pulmonary tuberculosis: a case-control study

Abstract

Objectives: To investigate the risk factors in patients with drug-resistant tuberculosis (DR-TB) and clinical characteristics related to unfavorable anti-TB treatment outcomes.

Methods: A total of 961 pulmonary tuberculosis (TB) patients were included at West China Hospital of Sichuan University from January 2008 to November 2023. We analyzed the differences of clinical characteristics between DR-TB and drug-sensitive tuberculosis (DS-TB), and then compared these features in DR-TB patients with different outcomes. Multivariable logistic regression models were employed to quantify risk factors associated with DR-TB and adverse treatment outcomes.

Results: Among 961 pulmonary TB patients, a history of anti-TB treatment [odds ratio (OR), 3.289; 95% confidence interval (CI), 2.359-4.604] and CT-scan cavities (OR, 1.512; 95% CI, 1.052-2.168) increased DR-TB risk. A total of 214 DR-TB patients were followed for a median of 24.5 months. Among them, 116/214 (54.2%) patients achieved favorable outcomes. Prior anti-TB treatment (OR, 1.927; 95% CI, 1.033-3.640), multidrug-resistant tuberculosis (MDR-TB) (OR, 2.558; 95% CI, 1.272-5.252), positive sputum bacteriology (OR, 2.116; 95% CI, 1.100-4.134), and pleural effusion (OR, 2.097; 95% CI, 1.093-4.082) were associated with unfavorable outcomes, while isoniazid-resistant TB patients showed better outcomes (OR, 0.401; 95% CI, 0.181-0.853). The clinical model for unfavorable outcome prediction of DR-TB achieved an area under the curve (AUC) of 0.754 (95% CI, 0.690-0.818).

Conclusions: Treatment history of anti-TB not only increases the risk of the emergence of DR-TB, but also potentially leads to treatment failure during re-treatment in DR-TB patients. Drug resistance subtypes, radiological characteristics, and the results of sputum smear or culture may affect the treatment outcome of DR-TB.

Keywords

drug-resistant tuberculosis / multidrug-resistant tuberculosis / anti-TB treatment / clinical characteristics / risk factors / treatment outcome

Acknowledgments

This research was supported by the National Natural Science Foundation of China (grant No. 82341083), the 1.3.5 Project for Disciplines Excellence of West China Hospital, Sichuan University (grant No. ZYYC23027), the 1·3·5 projects for Artificial Intelligence of West China Hospital, Sichuan University (grant No. ZYAI24016), and the 1·3·5 Project of State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University (grant No. RHM24208). We are grateful to the staff in our research groups involved in the study for their valuable contributions and discussions.

Author contributions

Changshu Li (Data curation, Formal analysis, Investigation, Writing - original draft, Writing - review & editing), Shufan Liang (Data curation, Formal analysis, Investigation, Writing - original draft), Xue Wang (Data curation), Su Lui (Project administration, Writing - review & editing), and Chengdi Wang (Funding acquisition, Resources, Supervision).

Supplementary data

Supplementary data are available at PCMEDI Journal online.

Conflict of interest

None declared.

Ethics statement

This study was conducted in strict accordance with the principles of the Declaration of Helsinki, ensuring ethical integrity and participant rights. Written informed consent was obtained from all participants prior to sample collection, following standard ethical guidelines. The study protocol was approved by the Institutional Review Board of West China Hospital, Sichuan University (Approval No. 2023.2286). Informed consent, either verbal or written, was obtained as per local regulatory requirements, except in cases where waivers or exemptions were granted by the respective ethics committee.

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