title: Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: an optimized prediction model.
abstract: Retreatment of tuberculosis (TB) often fails in China, yet the risk factors associated with the failure remain unclear. To identify risk factors for the treatment failure of retreated pulmonary tuberculosis (PTB) patients, we analyzed the data of 395 retreated PTB patients who received retreatment between July 2009 and July 2011 in China. PTB patients were categorized into 'success' and 'failure' groups by their treatment outcome. Univariable and multivariable logistic regression were used to evaluate the association between treatment outcome and socio-demographic as well as clinical factors. We also created an optimized risk score model to evaluate the predictive values of these risk factors on treatment failure. Of 395 patients, 99 (25·1%) were diagnosed as retreatment failure. Our results showed that risk factors associated with treatment failure included drug resistance, low education level, low body mass index (6 months), standard treatment regimen, retreatment type, positive culture result after 2 months of treatment, and the place where the first medicine was taken. An Optimized Framingham risk model was then used to calculate the risk scores of these factors. Place where first medicine was taken (temporary living places) received a score of 6, which was highest among all the factors. The predicted probability of treatment failure increases as risk score increases. Ten out of 359 patients had a risk score >9, which corresponded to an estimated probability of treatment failure >70%. In conclusion, we have identified multiple clinical and socio-demographic factors that are associated with treatment failure of retreated PTB patients. We also created an optimized risk score model that was effective in predicting the retreatment failure. These results provide novel insights for the prognosis and improvement of treatment for retreated PTB patients.
authors.affiliation: School of Public Health,Inner Mongolia Medical University,Hohhot 010110,China.
authors.forename: X-M
authors.initials: XM
authors.lastname: Wang
authors.affiliation: School of Public Health,Inner Mongolia Medical University,Hohhot 010110,China.
authors.forename: S-H
authors.initials: SH
authors.lastname: Yin
authors.affiliation: Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing Chest Hospital,Beijing 101149,China.
authors.forename: J
authors.initials: J
authors.lastname: Du
authors.affiliation: School of Public Health,Inner Mongolia Medical University,Hohhot 010110,China.
authors.forename: M-L
authors.initials: ML
authors.lastname: Du
authors.affiliation: Department of Social Medicine and Health Education,School of Public Health,Peking University,Beijing 100191,China.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Wang
authors.affiliation: Division for NCD Control and Prevention and Community Health,Center for Disease Control and Prevention in China,Beijing 102200,China.
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.affiliation: Feinberg School of Medicine,Northwestern University,Chicago, IL 60611,USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Horbinski
authors.affiliation: Feinberg School of Medicine,Northwestern University,Chicago, IL 60611,USA.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Wu
authors.affiliation: School of Public Health,Inner Mongolia Medical University,Hohhot 010110,China.
authors.forename: H-Q
authors.initials: HQ
authors.lastname: Zheng
authors.affiliation: School of Public Health,Inner Mongolia Medical University,Hohhot 010110,China.
authors.forename: X-Q
authors.initials: XQ
authors.lastname: Xu
authors.affiliation: Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing Chest Hospital,Beijing 101149,China.
authors.forename: W
authors.initials: W
authors.lastname: Shu
authors.affiliation: College of Traditional Chinese Medicine,Inner Mongolia Medical University,Hohhot 010110,China.
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019233:Retreatment / Q000706:statistics & numerical data; D012307:Risk Factors; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
keywords: Pulmonary tuberculosis; retreatment; risk factors; risk score