title: Mortality among MDR-TB cases: comparison with drug-susceptible tuberculosis and associated factors.
abstract: BACKGROUND
  An increase in multidrug-resistant tuberculosis (MDR-TB) cases is evident worldwide. Its management implies a complex treatment, high costs, more toxic anti-tuberculosis drug use, longer treatment time and increased treatment failure and mortality. The aims of this study were to compare mortality between MDR and drug-susceptible cases of tuberculosis, and to determine risk factors associated with mortality among MDR-TB cases.
  
  
  RESULTS
  A retrospective cohort study was performed using data from clinical records of the National Strategy for Prevention and Control of Tuberculosis in Lima, Peru. In the first objective, MDR-TB, compared to drug-susceptible cases, was the main exposure variable and time to death, censored at 180 days, the outcome of interest. For the second objective, different variables obtained from clinical records were assessed as potential risk factors for death among MDR-TB cases. Cox regression analysis was used to determine hazard ratios (HR) and 95% confidence intervals (95%CI). A total of 1,232 patients were analyzed: mean age 30.9 ±14.0 years, 60.0% were males. 61 patients (5.0%) died during treatment, whereas the MDR-TB prevalence was 19.2%. MDR-TB increased the risk of death during treatment (HR = 7.5; IC95%: 4.1-13.4) when compared to presumed drug-susceptible cases after controlling for potential confounders. Education level (p = 0.01), previous TB episodes (p<0.001), diabetes history (p<0.001) and HIV infection (p = 0.04) were factors associated with mortality among MDR-TB cases.
  
  
  CONCLUSIONS
  MDR-TB is associated with an increased risk of death during treatment. Lower education, greater number of previous TB episodes, diabetes history, and HIV infection were independently associated with mortality among MDR-TB cases. New strategies for appropriate MDR-TB detection and management should be implemented, including drug sensitivity tests, diabetes and HIV screening, as well as guarantee for a complete adherence to therapy.
authors: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
authors: Kocfa
authors: K
authors: Chung-Delgado
authors: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
authors: Sonia
authors: S
authors: Guillen-Bravo
authors: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
authors: Alejandro
authors: A
authors: Revilla-Montag
authors: Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
authors: Antonio
authors: A
authors: Bernabe-Ortiz
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010568:Peru; D016016:Proportional Hazards Models; D012307:Risk Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology
chemical_list: D000995:Antitubercular Agents