Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia
Brugueras Torrella, Silvia (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva i Salut Pública)
Molina-Pinargote, Israel (Serveis Clínics (Barcelona))
Casas, Xavier (Serveis Clínics (Barcelona))
González, Yoel-Domingo (Serveis Clínics (Barcelona))
Forcada, Nuria (Serveis Clínics (Barcelona))
Romero, Dora (Serveis Clínics (Barcelona))
Rodés, Anna (Agència de Salut Pública de Barcelona)
Altet Gómez, María Neus (Serveis Clínics (Barcelona))
Maldonado, José (Serveis Clínics (Barcelona))
Martin-Sánchez, Mario (Parc de Salut MAR de Barcelona)
Caylà, Joan A. (Fundació de la Unitat d'Investigació en Tuberculosi de Barcelona)
Orcau, Àngels (Fundació de la Unitat d'Investigació en Tuberculosi de Barcelona)
Rius i Gibert, Maria Cristina (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva i Salut Pública)
Millet, Joan-Pau (Fundació de la Unitat d'Investigació en Tuberculosi de Barcelona)

Data:	2020
Resum:	Patients with a history of tuberculosis (TB) have a high probability of recurrence because long-term cure is not always maintained in successfully treated patients. The aim of this study was to identify the probability of TB recurrence and its predictive factors in a cohort of socially vulnerable patients who completed treatment in the TB referral center in Catalonia, which acts as the center for patients with social and health problems. This retrospective open cohort study included all patients diagnosed with TB who were admitted and successfully treated in Serveis Clínics between 2000 and 2016 and who remained disease-free for a minimum of 1 year after treatment completion. We calculated the incidence density of TB recurrences per person-years of follow-up. We also estimated the cumulative incidence of TB recurrence at 1, 2, 5, and 10 years of follow-up. Bivariate analysis was conducted using Kaplan-Meier curves. Multivariate analysis was conducted using Cox regression. Hazard ratios (HR) were calculated with their 95% confidence intervals (95%CI). There were 839 patients and 24 recurrences (2. 9%), representing 0. 49 per 100 person-years. The probability of a recurrence was 0. 63% at 1 year of follow-up, 1. 35% at 2 years, and 3. 69% at 5 years. The multivariate analysis showed that the predictive factors of recurrence were age older than 34 years (aHR = 3. 90; CI = 1. 06-14. 34 at age 35-45 years and aHR = 3. 88; CI = 1. 02-14. 80 at age >45 years) and resistance to at least one anti-TB drug (aHR = 2. 91; CI = 1. 11-7. 65). Attention should be paid to socially vulnerable persons older than 34 years with a previous episode of resistant TB. Surveillance resources should be directed toward adequately treated patients who nevertheless have a high risk of recurrence.
Nota:	Altres ajuts: Sociedad Española de Neumología y Cirugía Torácica (088/2015)
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 15 (january 2020) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0227291
PMID: 31940383

18 p, 1.6 MB

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