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Mortality in patients with multidrug-resistant tuberculosis in a tertiary care hospital in Lima, Peru
Mortalidad en pacientes con tuberculosis multidrogoresistente en un hospital de tercer nivel de Lima, Perú
Palabras clave:
Tuberculosis, Multidrug-Resistance, Mortality, Risk Factors (en)Tuberculosis resistente a múltiples medicamentos, Mortalidad, Factores de riesgo (es)
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Introduction: In recent years, an increase in the number of multidrug-resistant (MDR) tuberculosis (MDR-TB) cases has been reported worldwide. This implies an increase in mortality rates due to the complex treatment of MDR-TB and the presence of different risk factors in these patients.
Objective: To determine the risk factors for mortality in patients with MDR-TB treated at the pulmonology service of the Hospital Nacional Dos de Mayo (Lima, Peru) between 2014 and 2018.
Materials and methods: Retrospective case-control study conducted in 305 MDR-TB patients hospitalized between 2014 and 2018 (cases: 62; controls: 243). Cases were defined as patients who died. Data on variables of interest were obtained from medical records. A bivariate and a multivariate analysis (logistic regression model) were performed by calculating odds ratios (crude and adjusted) to determine the association between the variables considered in this study and mortality.
Results: Participants’ mean age was 48.2±19.4 years. In the multivariate analysis, having diabetes mellitus (aOR: 8.580, 95%CI: 1.805-40.785), having a history of TB (aOR: 4.923, 95%CI: 1.474-16.446), being an active smoker (aOR: 12.189, 95%CI: 3.047-48.759), using psychoactive drugs (aOR: 9.428, CI95%: 2.737-32.482), and being malnourished (aOR: 6.652, CI95%: 1.432-30.888) were associated with an increased risk of mortality due to MDR-TB.
Conclusions: In this study, several risk factors for mortality in MDR-TB patients were identified. Strategies for the adequate management of MDR-TB, particularly in patients with the mortality risk factors identified here, must be implemented at the Hospital Nacional Dos de Mayo, as well as other hospitals that provide healthcare services to these patients in Lima.
Introducción. En los últimos años se ha reportado un aumento en el número de casos de tuberculosis (TB) multidrogoresistente (MDR) a nivel mundial. Esto implica un incremento en las tasas de mortalidad debido a que el tratamiento de la TB-MDR es complejo y a la presencia de diferentes factores de riesgo en estos pacientes.
Objetivo. Determinar los factores de riesgo de mortalidad en pacientes con TB-MDR atendidos en el Servicio de Neumología del Hospital Nacional Dos de Mayo (Lima, Perú) entre 2014 y 2018.
Materiales y métodos. Estudio retrospectivo de casos y controles realizado en 305 pacientes con TB-MDR hospitalizados entre 2014 y 2018 (casos: 62; controles: 243). Los casos se definieron como aquellos pacientes que fallecieron. Los datos de las variables de interés se obtuvieron de las historias clínicas. Se realizó un análisis bivariado y uno multivariado (modelo de regresión logística) mediante el cálculo de odds ratio (crudos y ajustados) para determinar la asociación entre las variables consideradas y la mortalidad.
Resultados. El promedio de edad fue 48.2±19.4 años. En el análisis multivariado, tener diabetes mellitus (ORa: 8.580, IC95%: 1.805-40.785), tener antecedente de TB (ORa: 4.923, IC95%: 1.474-16.446), la presencia de tabaquismo (ORa: 12.189, IC95%: 3.047-48.759), la presencia de consumo activo de sustancias psicoactivas (ORa: 9.428, IC95%: 2.737-32.482) y estar desnutrido (ORa: 6.652, IC95%: 1.432-30.888) se asociaron con un mayor riesgo de mortalidad por TB-MDR.
Conclusiones. En el presente estudio se identificaron varios factores de riesgo de mortalidad en pacientes con TB-MDR. En el Hospital Nacional Dos de Mayo, así como en otros hospitales de Lima que atiendan estos pacientes, se deben implementar estrategias para el manejo adecuado de la TB-MDR, en particular en pacientes con los factores de riesgo de mortalidad aquí identificados.
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1. World Health Organization (WHO). Global Tuberculosis Report 2020 Geneva: WHO; 2020.
2. Nicholson TJ, Hoddinott G, Seddon JA, Claassens MM, van der Zalm MM, Lopez E, et al. A systematic review of risk factors for mortality among tuberculosis patients in South Africa. Syst Rev. 2023;12(1):23. https://doi.org/mq62.
3. Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H, et al. Impact of diabetes and smoking on mortality in tuberculosis. PLoS One. 2013;8(2):e58044. https://doi.org/gmvfwj.
4. Gayoso R, Dalcolmo M, Braga JU, Barreira D. Predictors of mortality in multidrug-resistant tuberculosis patients from Brazilian reference centers, 2005 to 2012. Braz J Infect Dis. 2018;22(4):305-10. https://doi.org/mrgw.
5. World Medical Association (WMA). WMA Declaration of Helsinki - Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.
6. Alemu A, Bitew ZW, Worku T, Gamtesa DF, Alebel A. Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis. PLoS One. 2021;16(6):e0253848. https://doi.org/gnn7pp.
7. Chingonzoh R, Manesen MR, Madlavu MJ, Sopiseka N, Nokwe M, Emwerem M, et al. Risk factors for mortality among adults registered on the routine drug resistant tuberculosis reporting database in the Eastern Cape Province, South Africa, 2011 to 2013. PLoS One. 2018;13(8):e0202469. https://doi.org/gd4hk4.
8. Kizito E, Musaazi J, Mutesasira K, Twinomugisha F, Namwanje H, Kiyemba T, et al. Risk factors for mortality among patients diagnosed with multi-drug resistant tuberculosis in Uganda- a case-control study. BMC Infect Dis. 2021;21(1):292. https://doi.org/mrgx.
9. Chung-Delgado K, Guillen-Bravo S, Revilla-Montag A, Bernabe-Ortiz A. Mortality among MDR-TB Cases: Comparison with Drug-Susceptible Tuberculosis and Associated Factors. PLoS One. 2015;10(3):e0119332. https://doi.org/f7b7v6.
10. Nguyen CH, Pascopella L, Barry PM. Association between diabetes mellitus and mortality among patients with tuberculosis in California, 2010-2014. Int J Tuberc Lung Dis. 2018;22(11):1269-76. https://doi.org/gfhndt.
11. Liu Y, Zheng Y, Chen J, Shi Y, Shan LY, Wang S, et al. Tuberculosis-associated mortality and its risk factors in a district of Shanghai, China: a retrospective cohort study. Int J Tuberc Lung Dis. 2018;22(6):655-60. https://doi.org/gds9hp.
12. Cadena J, Rathinavelu S, Lopez-Alvarenga JC, Restrepo BI. The re-emerging association between tuberculosis and diabetes: Lessons from past centuries. Tuberculosis (Edinb). 2019;116S:S89-97. https://doi.org/mrgz.
13. Bernabé-Ortiz A. Factores asociados a supervivencia en pacientes con tuberculosis en Lima, Perú. Rev Chil Infectol. 2008;25(2):104-7. https://doi.org/btkr9x.
14. De León N, Gordillo R, Chocó A, Mejía-Villatoro C. Morbi-mortalidad en pacientes con infección por Mycobacterium tuberculosis comprobada, y co-infección VIH-Tuberculosis en Hospital Roosevelt en Guatemala. Avances en Enfermedades Infecciosas Guatemala. 2016;20(Suppl 1):31-8.
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Derechos de autor 2024 Revista de la Facultad de Medicina
Esta obra está bajo una licencia Creative Commons Reconocimiento 3.0 Unported.
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