The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Timing and predictors of death during treatment in patients with multidrug/rifampin-resistant tuberculosis in South Korea

  • Eunjeong Son (Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Hongjo Choi (Division of Health Policy and Management, Korea University College of Health Science ) ;
  • Jeongha Mok (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Young Ae Kang (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Dawoon Jeong (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Doosoo Jeon (Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine)
  • Received : 2024.01.29
  • Accepted : 2024.03.28
  • Published : 2024.07.01
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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

Acknowledgement

This study used the National Health Information Database (NHIS-2019-1-662) of the National Health Insurance Service (NHIS).

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