Korean J Intern Med.
2024 Jul;39(4):640-649. 10.3904/kjim.2024.029.
Timing and predictors of death during treatment in patients with multidrug/rifampin-resistant tuberculosis in South Korea
- Affiliations
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- 1Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- 2Division of Health Policy and Management, Korea University College of Health Science, Seoul, Korea
- 3Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 5Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- KMID: 2556913
- DOI: http://doi.org/10.3904/kjim.2024.029
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.
