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J Korean Med Sci.  2025 May;40(17):e73. 10.3346/jkms.2025.40.e73.

Nutrition Status and Comorbidities Are Important Factors Associated With Mortality During Anti-Tuberculosis Treatment

Affiliations
  • 1Department of Internal Medicine and Environmental Health Center, Kangwon National University Hospital, Chuncheon, Korea
  • 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
  • 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 7Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 8Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 9Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
  • 11Department of Pulmonary and Critical Care Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
  • 12Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
  • 13Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
  • 14Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
  • 15Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background
The increasing incidence and mortality rates of tuberculosis among older individuals who suffer from multiple morbidities and are vulnerable to malnutrition are major obstacles to efforts to eradicate tuberculosis in the Republic of Korea. Herein, we identified the factors associated with mortality during anti-tuberculosis treatment in patients with pulmonary tuberculosis.
Methods
We conducted a case-control study and extracted data from the database of a multi-center prospective observational cohort study in Korea. Among the participants with rifampicin-susceptible pulmonary tuberculosis, the survival group was defined as those who successfully completed treatment within one year, whereas the mortality group was defined as those who died during treatment. Univariable and multivariable logistic regression analyses were performed to identify factors associated with TB mortality.
Results
Among 1,119 participants with pulmonary TB registered between 2019 and 2021, 799 and 59 were grouped in the survival and mortality groups, respectively. Age, positive smear results, alarming symptoms, nutrition risk score, Charlson comorbidity index score, and initial standard treatment regimen were significant based on univariable analysis and were selected for the multivariable logistic regression model. Nutrition risk score (adjusted odds ratio, 2.44; 95% confidence interval, 1.72–3.48) and Charlson comorbidity index score (adjusted odds ratio, 1.62; 95% confidence interval, 1.35–1.94) remained statistically significant in the multivariate analysis.
Conclusion
Nutritional status and comorbidities at baseline were identified as important factors associated with mortality in patients with pulmonary tuberculosis.

Keyword

Death; Nutrition; Morbidity; Chronic Disease; Tuberculosis

Figure

  • Fig. 1 Flow chart of participant enrollment.TB = tuberculosis, MDR/RR-TB = multidrug-resistant/rifampicin-resistant tuberculosis.


Reference

1. Jeong Y, Min J. Impact of COVID-19 pandemic on tuberculosis preventive services and their post-pandemic recovery strategies: a rapid review of literature. J Korean Med Sci. 2023; 38(5):e43. PMID: 36747365.
2. World Health Organization. Global Tuberculosis Report 2021. Geneva, Switzerland: World Health Organization;2021.
3. Min J, Jeong Y, Kim HW, Kim JS. Tuberculosis notification and incidence – Republic of Korea, 2022. Tuberc Respir Dis (Seoul). 2024; 87(3):411–413. PMID: 38414370.
4. Cho MM, Kim HW, Kim JS, Min J. TB in ageing populations: lessons from Japan and Korea. Int J Tuberc Lung Dis. 2023; 27(11):869–871. PMID: 37880893.
5. Nordholm AC, Andersen AB, Wejse C, Norman A, Ekstrøm CT, Andersen PH, et al. Mortality, risk factors, and causes of death among people with tuberculosis in Denmark, 1990-2018. Int J Infect Dis. 2023; 130:76–82. PMID: 36907546.
6. Jeong YJ, Park JS, Kim HW, Min J, Ko Y, Oh JY, et al. Deaths from tuberculosis: differences between tuberculosis-related and non-tuberculosis-related deaths. Front Public Health. 2023; 11:1207284. PMID: 37719730.
7. Wagnew F, Alene KA, Kelly M, Gray D. Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: a multicenter retrospective cohort study. J Infect. 2024; 89(1):106175. PMID: 38729526.
8. Bhargava A, Chatterjee M, Jain Y, Chatterjee B, Kataria A, Bhargava M, et al. Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS One. 2013; 8(10):e77979. PMID: 24205052.
9. World Health Organization. Definitions and Reporting Framework for Tuberculosis – 2013 Revision. Geneva, Switzerland: World Health Organization;2013.
10. Kim DK, Kim HJ, Kwon SY, Yoon HI, Lee CT, Kim YW, et al. Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis. Eur Respir J. 2008; 32(4):1031–1036. PMID: 18508814.
11. Waitt CJ, Squire SB. A systematic review of risk factors for death in adults during and after tuberculosis treatment. Int J Tuberc Lung Dis. 2011; 15(7):871–885. PMID: 21496360.
12. Lui G, Wong RY, Li F, Lee MK, Lai RW, Li TC, et al. High mortality in adults hospitalized for active tuberculosis in a low HIV prevalence setting. PLoS One. 2014; 9(3):e92077. PMID: 24642794.
13. Bhargava A, Bhargava M, Meher A, Benedetti A, Velayutham B, Sai Teja G, et al. Nutritional supplementation to prevent tuberculosis incidence in household contacts of patients with pulmonary tuberculosis in India (RATIONS): a field-based, open-label, cluster-randomised, controlled trial. Lancet. 2023; 402(10402):627–640. PMID: 37567200.
14. Lin CH, Lin CJ, Kuo YW, Wang JY, Hsu CL, Chen JM, et al. Tuberculosis mortality: patient characteristics and causes. BMC Infect Dis. 2014; 14(1):5. PMID: 24387757.
15. Edwards BD, Mah H, Sabur NF, Brode SK. Hepatotoxicity and tuberculosis treatment outcomes in chronic liver disease. J Assoc Med Microbiol Infect Dis Can. 2023; 8(1):64–74. PMID: 37008589.
16. Chung SJ, Byeon SJ, Choi JH. Analysis of adverse drug reactions to first-line anti-tuberculosis drugs using the Korea Adverse Event Reporting System. J Korean Med Sci. 2022; 37(16):e128. PMID: 35470602.
17. Yoon JY, Kim TO, Kim JS, Kim HW, Lee EG, Jung SS, et al. Impact of pyrazinamide usage on serious adverse events in elderly tuberculosis patients: a multicenter cohort study. PLoS One. 2024; 19(9):e0309902. PMID: 39325726.
18. Lim J, Kim JS, Kim HW, Kim YH, Jung SS, Kim JW, et al. Metabolic disorders are associated with drug-induced liver injury during antituberculosis treatment: a multicenter prospective observational cohort study in Korea. Open Forum Infect Dis. 2023; 10(8):ofad422. PMID: 37654787.
19. Kim KH, Kim HW, Kim YH, Park Y, Jung SS, Kim JW, et al. Effect of complicated, untreated and uncontrolled diabetes and pre-diabetes on treatment outcome among patients with pulmonary tuberculosis. Respirology. 2024; 29(7):624–632. PMID: 38539055.
20. Min J, Kim JS, Kim HW, Shin AY, Koo HK, Lee SS, et al. Clinical profiles of early and tuberculosis-related mortality in South Korea between 2015 and 2017: a cross-sectional study. BMC Infect Dis. 2019; 19(1):735. PMID: 31438876.
21. Koo HK, Min J, Kim HW, Ko Y, Oh JY, Jeong YJ, et al. Cluster analysis categorizes five phenotypes of pulmonary tuberculosis. Sci Rep. 2022; 12(1):10084. PMID: 35710915.
22. World Health Organization. Global Tuberculosis Report 2023. Geneva, Switzerland: World Health Organization;2023.
23. Min J, Kim HW, Kim JS. Tuberculosis: Republic of Korea, 2021. Tuberc Respir Dis (Seoul). 2023; 86(1):67–69. PMID: 36281544.
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