Predictors of death among drug-resistant tuberculosis patients in Kuala Lumpur, Malaysia: A retrospective cohort study from 2009 to 2013

Noorsuzana Mohd Shariff, Shamsul Azhar Shah, Fadzilah Kamaludin

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n = 426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3% (n = 65) of the patients died. Among the study patients, 70.9% were monoresistant TB cases, 9.4% were poly-resistant TB and 19.7% were MDR-TB. MDR-TB [adjusted hazard ratio (aHR) = 2.23, 95% confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR = 5.95, 95% CI 2.30-15.41), Chinese (aHR = 4.01, 95% CI 1.38-11.66) and Indian (aHR = 3.76, 95% CI 1.19-11.85)], coronary heart disease (aHR = 6.82, 95% CI 2.16-21.50), drug abuse (aHR = 3.79, 95% CI 2.07-6.93) and treatment non-compliance (aHR = 1.81, 95% CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.

Original languageEnglish
Pages (from-to)102-107
Number of pages6
JournalJournal of Global Antimicrobial Resistance
Volume6
DOIs
Publication statusPublished - 1 Sep 2016

Fingerprint

Multidrug-Resistant Tuberculosis
Malaysia
Cohort Studies
Retrospective Studies
Confidence Intervals
Substance-Related Disorders
Coronary Disease
Tuberculosis
Survival
Proportional Hazards Models
Public Health
Regression Analysis
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • Drug-resistant tuberculosis
  • Malaysia
  • Multidrug-resistant
  • Predictors of death
  • Survival

ASJC Scopus subject areas

  • Immunology
  • Microbiology
  • Immunology and Allergy
  • Microbiology (medical)

Cite this

Predictors of death among drug-resistant tuberculosis patients in Kuala Lumpur, Malaysia : A retrospective cohort study from 2009 to 2013. / Mohd Shariff, Noorsuzana; Shah, Shamsul Azhar; Kamaludin, Fadzilah.

In: Journal of Global Antimicrobial Resistance, Vol. 6, 01.09.2016, p. 102-107.

Research output: Contribution to journalReview article

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abstract = "The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n = 426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3{\%} (n = 65) of the patients died. Among the study patients, 70.9{\%} were monoresistant TB cases, 9.4{\%} were poly-resistant TB and 19.7{\%} were MDR-TB. MDR-TB [adjusted hazard ratio (aHR) = 2.23, 95{\%} confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR = 5.95, 95{\%} CI 2.30-15.41), Chinese (aHR = 4.01, 95{\%} CI 1.38-11.66) and Indian (aHR = 3.76, 95{\%} CI 1.19-11.85)], coronary heart disease (aHR = 6.82, 95{\%} CI 2.16-21.50), drug abuse (aHR = 3.79, 95{\%} CI 2.07-6.93) and treatment non-compliance (aHR = 1.81, 95{\%} CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.",
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N2 - The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n = 426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3% (n = 65) of the patients died. Among the study patients, 70.9% were monoresistant TB cases, 9.4% were poly-resistant TB and 19.7% were MDR-TB. MDR-TB [adjusted hazard ratio (aHR) = 2.23, 95% confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR = 5.95, 95% CI 2.30-15.41), Chinese (aHR = 4.01, 95% CI 1.38-11.66) and Indian (aHR = 3.76, 95% CI 1.19-11.85)], coronary heart disease (aHR = 6.82, 95% CI 2.16-21.50), drug abuse (aHR = 3.79, 95% CI 2.07-6.93) and treatment non-compliance (aHR = 1.81, 95% CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.

AB - The emergence of drug-resistant tuberculosis (TB) is a major public health threat. However, little is known about the predictors of death in drug-resistant TB in Malaysia. This study aimed to determine the predictors of death in drug-resistant TB patients, including multidrug-resistant TB (MDR-TB), in Kuala Lumpur, Malaysia. This study adopted a retrospective cohort study design and involved laboratory-confirmed drug-resistant TB patients (n = 426) from January 2009 to June 2013. A Cox regression model and Kaplan-Meier curves were used to model the outcome measure. Data were analysed by using SPSS v.20.0 for Windows. In this study, 15.3% (n = 65) of the patients died. Among the study patients, 70.9% were monoresistant TB cases, 9.4% were poly-resistant TB and 19.7% were MDR-TB. MDR-TB [adjusted hazard ratio (aHR) = 2.23, 95% confidence interval (CI) 1.26-3.95], ethnicity [Malay (aHR = 5.95, 95% CI 2.30-15.41), Chinese (aHR = 4.01, 95% CI 1.38-11.66) and Indian (aHR = 3.76, 95% CI 1.19-11.85)], coronary heart disease (aHR = 6.82, 95% CI 2.16-21.50), drug abuse (aHR = 3.79, 95% CI 2.07-6.93) and treatment non-compliance (aHR = 1.81, 95% CI 1.01-3.27) were independent predictors of poorer survival in the multivariate Cox regression analysis. This study suggests that MDR-TB, local ethnicity, coronary heart disease, history of drug abuse and treatment non-compliance are factors predicting poor survival in drug-resistant TB patients. More emphasis should be given to the management of drug-resistant TB patients with these characteristics to achieve better treatment outcomes.

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