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Risk Factors for Unfavorable Outcomes of Tuberculosis in Korea: Implications for Patient-Centered Care in Tuberculosis Treatment

Authors
 Hye Young Hong  ;  Youngmok Park  ;  Seung Hyun Yong  ;  Ala Woo  ;  Ah Young Leem  ;  Su Hwan Lee  ;  Kyung Soo Chung  ;  Sang Hoon Lee  ;  Song Yee Kim  ;  Eun Young Kim  ;  Ji Ye Jung  ;  Moo Suk Park  ;  Young Sam Kim  ;  Sung Jae Shin  ;  Young Ae Kang 
Citation
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.39(2) : e4, 2024-01 
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
ISSN
 1011-8934 
Issue Date
2024-01
MeSH
Antitubercular Agents* / adverse effects ; Humans ; Male ; Middle Aged ; Patient-Centered Care ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Tuberculosis* / drug therapy ; Tuberculosis* / epidemiology
Keywords
Lost to Follow-Up ; Patient-Centered Care ; Risk Factors ; Tuberculosis
Abstract
Background: The treatment success rate for tuberculosis (TB) has stagnated at 80–81% in South Korea, indicating unsatisfactory outcomes. Enhancing treatment success rate necessitates the development of individualized treatment approaches for each patient. This study aimed to identify the risk factors associated with unfavorable treatment outcomes to facilitate tailored TB care.

Methods: We retrospectively analyzed the data of patients with active TB between January 2019 and December 2020 at a single tertiary referral center. We classified unfavorable treatment outcomes according to the 2021 World Health Organization guidelines as follows: “lost to follow-up” (LTFU), “not evaluated” (NE), “death,” and “treatment failure” (TF).

Moreover, we analyzed risk factors for each unfavorable outcome using Cox proportional hazard regression analysis.

Results: A total of 659 patients (median age 62 years; male 54.3%) were included in the study.

The total unfavorable outcomes were 28.1%: 4.6% LTFU, 9.6% NE, 9.1% deaths, and 4.9% TF. Multivariate analysis showed that a culture-confirmed diagnosis of TB was associated with a lower risk of LTFU (adjusted hazard ratio [aHR], 0.25; 95% confidence interval [CI], 0.10–0.63), whereas the occurrence of adverse drug reactions (ADRs) significantly increased the risk of LTFU (aHR, 6.63; 95% CI, 2.63–16.69). Patients living far from the hospital (aHR, 4.47; 95% CI, 2.50–7.97) and those with chronic kidney disease (aHR, 3.21; 95% CI, 1.33–7.75) were at higher risk of being transferred out to other health institutions (NE). Higher mortality was associated with older age (aHR, 1.06; 95% CI, 1.04–1.09) and comorbidities. The ADRs that occurred during TB treatment were a risk factor for TF (aHR, 6.88; 95% CI, 2.24–21.13).

Conclusion: Unfavorable outcomes of patients with TB were substantial at a tertiary referral center, and the risk factors for each unfavorable outcome varied. To improve treatment outcomes, close monitoring and the provision of tailored care for patients with TB are necessary.
Files in This Item:
T202400763.pdf Download
DOI
10.3346/jkms.2024.39.e4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Microbiology (미생물학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ae(강영애) ORCID logo https://orcid.org/0000-0002-7783-5271
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Kim, Young Sam(김영삼) ORCID logo https://orcid.org/0000-0001-9656-8482
Kim, Eun Young(김은영) ORCID logo https://orcid.org/0000-0002-3281-5744
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Park, Youngmok(박영목) ORCID logo https://orcid.org/0000-0002-5669-1491
Shin, Sung Jae(신성재) ORCID logo https://orcid.org/0000-0003-0854-4582
Yong, Seung Hyun(용승현)
Woo, Ala(우아라)
Lee, Sang Hoon(이상훈) ORCID logo https://orcid.org/0000-0002-7706-5318
Lee, Su Hwan(이수환) ORCID logo https://orcid.org/0000-0002-3487-2574
Leem, Ah Young(임아영) ORCID logo https://orcid.org/0000-0001-5165-3704
Jung, Kyung Soo(정경수) ORCID logo https://orcid.org/0000-0003-1604-8730
Jung, Ji Ye(정지예) ORCID logo https://orcid.org/0000-0003-1589-4142
Hong, Hye Young(홍혜영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198570
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