Risk Factors of Retreatment Pulmonary Tuberculosis Patients with Unfavorable Treatment Outcome in China: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YINShao-hua ¹ ^# ,  DUMao-lin ¹ ^# , DUJian ² , WUJing ³ , WANGPei-yu ⁴ , SHUWei ¹ , HAORui-qi ¹ , LIShi-yuan ¹ , LIANGDan-yan ¹ , WANGRui-qi ¹ ,  WANGXue-mei ¹

1. School of Public Health, Inner Mongolia Medical University, Hohhot 010110, China;
2. Beijing Chest Hospital, Capital Medical University/Clinical Center on Tuberculosis Control, China Center of Disease Control, Beijing 101149, China;
3. Division for NCD Control and Prevention and Community Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
4. Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China;

Corresponding author：

WANGXue-mei, Email: wangxm_zsu@163.com

Keywords：

Tuberculosis, pulmonary; Retreatment; Unfavorable treatment outcome; Treatment failure; Meta-analysis

DOI：

10.7507/1672-2531.20160123

Video：

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Objective To systematically review the risk factors of retreatment pulmonary tuberculosis with unfavorable treatment outcome. Methods We electronically searched databases including CNKI, VIP, CBM and WanFang Date from inception to November 15^th 2015, to collect studies about the risk factors of retreatment pulmonary tuberculosis patients with unfavorable treatment outcome. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software. Results A total of 13 studies were included. The results of meta-analysis showed that significant association was found between retreatment pulmonary tuberculosis cases with unfavorable treatment outcome and such factors as the standard retreatment regimen (OR=4.98, 95%CI 2.95 to 8.39, P < 0.00001), drug-resistance (OR=4.22, 95%CI 1.85 to 9.63, P=0.0006), multi-drug resistance (OR=7.19, 95%CI 2.51 to 20.58, P=0.0002), status of cavitas (OR=1.80, 95%CI 1.20 to 2.71, P=0.005), TB-diabetes mellitus (OR=2.05, 95%CI 1.30 to 3.22, P=0.002) and high sputum smear load >2+(OR=2.07, 95%CI 1.30 to 3.29, P=0.002) in univariate-analysis, respectively. But, in multivariate-analysis, only TB-diabetes mellitus (OR=3.38, 95%CI 1.56 to 7.29, P=0.002) showed significant association with retreatment pulmonary tuberculosis cases with unfavorable treatment outcome. Conclusion Current evidence shows that TB-diabetes mellitus, standard retreatment regimen, drug-resistance, multi-drug resistance, status of cavitas and high sputum smear load >2+ are considered to be the risk factors for retreatment pulmonary tuberculosis cases with unfavorable treatment outcome. Especially, for patients with diabetes, the importance of management need to be reinforced to reduce the failure rate in the retreatment of pulmonary tuberculosis. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： YINShao-hua, DUMao-lin, DUJian, WUJing, WANGPei-yu, SHUWei, HAORui-qi, LIShi-yuan, LIANGDan-yan, WANGRui-qi, WANGXue-mei. Risk Factors of Retreatment Pulmonary Tuberculosis Patients with Unfavorable Treatment Outcome in China: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(7): 795-801. doi: 10.7507/1672-2531.20160123 Copy

1.	World Health Organization. Global Tuberculosis Report 2015. Geneva:WHO, 2015:1-149.
2.	Reis-Santos B, Gomes T, Locatelli R, et al. Treatment outcomes in tuberculosis patients with diabetes:a polytomous analysis using Brazilian surveillance system. PLoS One, 2014, 9(7):e100082.
3.	Kritski AL, Rodrigues de Jesus LS, Andrade MK, et al. Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest, 1997, 111(5):1162-1167.
4.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-605.
5.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version5.0.0[update February 2008]. The Cochrane Collaboration, 2008. Available at:www.cochrane-handbook.org.
6.	韩旻雁, 银恭举, 陈维清.中国人群鼻咽癌发病危险因素Meta分析.中国热带医学, 2005, 5(07):1442-1443.
7.	Hamling J, Lee P, Weitkunat R, et al. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med, 2008, 27(7):954-970.
8.	李晓松.医学统计学.北京:高等教育出版社, 2008:1-471.
9.	陈长生, 徐勇勇.第十四讲如何进行meta分析.中华预防医学杂志, 2003, 37(2):138-140.
10.	范玉美.首次复治肺结核病人疗效影响的因素分析.江苏:苏州大学, 2006.
11.	黄勇. 2003-2007年阿坝州涂阳肺结核发现和治疗分析.寄生虫病与感染性疾病, 2008, 6(4):193-196.
12.	唐恒发. 213例复治涂阳肺结核病例转归的影响因素分析.安徽预防医学杂志, 2008, 14(4):250-252.
13.	范冀缓, 谢艳光, 何广学, 等.黑龙江省耐药监测项目中肺结核治疗失败的原因分析.中国防痨杂志, 2009, 31(12):681-685.
14.	王静, 罗萍, 洪峰, 等. 223例复治涂阳肺结核患者治疗现状分析.中国防痨杂志, 2010, 32(7):376-379.
15.	杜建, 徐彩红, 杨应周, 等.标准短程化疗方案治疗初治复治肺结核失败原因分析.中国病原生物学杂志, 2012, 7(7):523-526.
16.	李鹏鹏, 张宏兰, 孙凯成. 352例复治涂阳肺结核患者治疗效果分析.临床肺科杂志, 2012, 17(4):669-670.
17.	段琼红, 陈聪, 张正斌, 等.武汉市首次复治涂阳肺结核治疗结局及影响因素分析.中国防痨杂志, 2013, 35(10):788-792.
18.	张志进. 416例复治涂阳肺结核患者治疗转归及影响因素分析.中外健康文摘, 2013, (38):872-73.
19.	孙钊, 孟炜丽, 李慧颖, 等.标准复治方案对复治菌阳肺结核患者的疗效观察.北京医学, 2014, 36(6):491-492.
20.	杜建, 高微微, 马艳, 等.优化方案和规范化方案对复治肺结核合并糖尿病的疗效.中华结核和呼吸杂志, 2015, 38(12):886-891.
21.	胡洁.嘉兴市结核病耐药情况及复治肺结核患者治疗方案比较的研究.浙江:浙江大学, 2015.
22.	李莉, 孙建胜, 张海清, 等.耐多药结核病成因及治疗效果的分析.预防医学论坛, 2015, 21(8):568-572.
23.	Alisjahbana B, Sahiratmadja E, Nelwan EJ, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis, 2007, 45(4):428-435.
24.	Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus:convergence of two epidemics. Lancet Infect Dis, 2009, 9(12):737-746.
25.	Dooley KE, Tang T, Golub JE, et al. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg, 2009, 80(4):634-639.
26.	Baker MA, Harries AD, Jeon CY, et al. The impact of diabetes on tuberculosis treatment outcomes:a systematic review. BMC Med, 2011, 9(81):1-15.
27.	何权瀛, 张波.应高度重视免疫功能低下患者的肺部感染.中华结核和呼吸杂志, 2012, 33(10):721-722.
28.	Nijland HM, Ruslami R, Stalenhoef JE, et al. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis, 2006, 43(7):848-854.
29.	Lenjisa J. Assessment of Tuberculosis Retreatment Case Rate and Its Treatment Outcomes at Adama Hospital Medical College, East Showa, Ethiopia. J Steroids Horm Sci, 2015, 06(1):1-6.
30.	Jones-Ló pez EC, Ayakaka I, Levin J, et al. Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda:a prospective cohort study. PLoS Med, 2011, 8(3):e1000427.
31.	Mpagama SG, Lekule IA, Mbuya AW, et al. The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania. Am J Trop Med Hyg, 2015, 93(2):212-215.
32.	Matthys F, Rigouts L, Sizaire V, et al. Outcomes after chemotherapy with WHO category II regimen in a population with high prevalence of drug resistant tuberculosis. PLoS One, 2009, 4(11):e7954.
33.	Kritski AL, Rodrigues De Jesus LS, Andrade MK, et al. Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest, 1997, 111(5):1162-1167.
34.	Espinal MA, Kim SJ, Suarez PG, et al. Standard short-course chemotherapy for drug-resistant tuberculosis:treatment outcomes in 6 countries. JAMA, 2000, 283(19):2537-2545.
35.	He GX, Xie YG, Wang LX, et al. Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment. PLoS One, 2010, 5(5):e10799.
36.	Green E, Obi CL, Nchabeleng M, et al. Drug-susceptibility patterns of Mycobacterium tuberculosis in Mpumalanga province, South Africa:possible guiding design of retreatment regimen. J Health Popul Nutr, 2010, 28(1):7-13.
37.	Mak A, Thomas A, Del Granado M, et al. Influence of multidrug resistance on tuberculosis treatment outcomes with standardized regimens. Am J Respir Crit Care Med, 2008, 178(3):306-312.
38.	Ogbera AO, Kapur A, Abdur-Razzaq H, et al. Clinical profile of diabetes mellitus in tuberculosis. BMJ Open Diabetes Res Care, 2015, 3(1):e000112.
39.	Tabarsi P, Chitsaz E, Tabatabaei V, et al. Revised Category II regimen as an alternative strategy for retreatment of Category I regimen failure and irregular treatment cases. Am J Ther, 2011, 18(5):343-349.
40.	Takarinda KC, Harries AD, Srinath S, et al. Treatment outcomes of adult patients with recurrent tuberculosis in relation to HIV status in Zimbabwe:a retrospective record review. BMC Public Health, 2011, 12(12):124.
41.	World Health Organization. Global Tuberculosis Report 2013, Geneva:WHO.
42.	Han LL, Sloutsky A, Canales R, et al. Acquisition of drug resistance in multidrug-resistant Mycobacterium tuberculosis during directly observed empiric retreatment with standardized regimens. Int J Tuberc Lung Dis, 2005, 9(7):818-821.
43.	Faustini A, Hall AJ, Perucci CA. Risk factors for multidrug resistant tuberculosis in Europe:a systematic review. Thorax, 2006, 61(2):158-163.
44.	Denholm J. The most recent report from the World Health Organization found that, worldwide, approximately 5% of new tuberculosis cases are caused by multidrug-resistant strains (MDR TB). J Travel Med, 2010, 17(3):216.
45.	Pieroni M, Tipparaju SK, Lun S, et al. Pyrido[1, 2-a]benzimidazole-based agents active against tuberculosis(TB), multidrug-resistant(MDR) TB and extensively drug-resistant(XDR) TB. ChemMedChem, 2011, 6(2):334-342.
46.	Prammananan T, Chaiprasert A, Leechawengwongs M. In vitro activity of linezolid against multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant (XDR)-TB isolates. Int J Antimicrob Agents, 2009, 33(2):190-191.

1. World Health Organization. Global Tuberculosis Report 2015. Geneva:WHO, 2015:1-149.
2. Reis-Santos B, Gomes T, Locatelli R, et al. Treatment outcomes in tuberculosis patients with diabetes:a polytomous analysis using Brazilian surveillance system. PLoS One, 2014, 9(7):e100082.
3. Kritski AL, Rodrigues de Jesus LS, Andrade MK, et al. Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest, 1997, 111(5):1162-1167.
4. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-605.
5. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version5.0.0[update February 2008]. The Cochrane Collaboration, 2008. Available at:www.cochrane-handbook.org.
6. 韩旻雁, 银恭举, 陈维清.中国人群鼻咽癌发病危险因素Meta分析.中国热带医学, 2005, 5(07):1442-1443.
7. Hamling J, Lee P, Weitkunat R, et al. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med, 2008, 27(7):954-970.
8. 李晓松.医学统计学.北京:高等教育出版社, 2008:1-471.
9. 陈长生, 徐勇勇.第十四讲如何进行meta分析.中华预防医学杂志, 2003, 37(2):138-140.
10. 范玉美.首次复治肺结核病人疗效影响的因素分析.江苏:苏州大学, 2006.
11. 黄勇. 2003-2007年阿坝州涂阳肺结核发现和治疗分析.寄生虫病与感染性疾病, 2008, 6(4):193-196.
12. 唐恒发. 213例复治涂阳肺结核病例转归的影响因素分析.安徽预防医学杂志, 2008, 14(4):250-252.
13. 范冀缓, 谢艳光, 何广学, 等.黑龙江省耐药监测项目中肺结核治疗失败的原因分析.中国防痨杂志, 2009, 31(12):681-685.
14. 王静, 罗萍, 洪峰, 等. 223例复治涂阳肺结核患者治疗现状分析.中国防痨杂志, 2010, 32(7):376-379.
15. 杜建, 徐彩红, 杨应周, 等.标准短程化疗方案治疗初治复治肺结核失败原因分析.中国病原生物学杂志, 2012, 7(7):523-526.
16. 李鹏鹏, 张宏兰, 孙凯成. 352例复治涂阳肺结核患者治疗效果分析.临床肺科杂志, 2012, 17(4):669-670.
17. 段琼红, 陈聪, 张正斌, 等.武汉市首次复治涂阳肺结核治疗结局及影响因素分析.中国防痨杂志, 2013, 35(10):788-792.
18. 张志进. 416例复治涂阳肺结核患者治疗转归及影响因素分析.中外健康文摘, 2013, (38):872-73.
19. 孙钊, 孟炜丽, 李慧颖, 等.标准复治方案对复治菌阳肺结核患者的疗效观察.北京医学, 2014, 36(6):491-492.
20. 杜建, 高微微, 马艳, 等.优化方案和规范化方案对复治肺结核合并糖尿病的疗效.中华结核和呼吸杂志, 2015, 38(12):886-891.
21. 胡洁.嘉兴市结核病耐药情况及复治肺结核患者治疗方案比较的研究.浙江:浙江大学, 2015.
22. 李莉, 孙建胜, 张海清, 等.耐多药结核病成因及治疗效果的分析.预防医学论坛, 2015, 21(8):568-572.
23. Alisjahbana B, Sahiratmadja E, Nelwan EJ, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis, 2007, 45(4):428-435.
24. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus:convergence of two epidemics. Lancet Infect Dis, 2009, 9(12):737-746.
25. Dooley KE, Tang T, Golub JE, et al. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg, 2009, 80(4):634-639.
26. Baker MA, Harries AD, Jeon CY, et al. The impact of diabetes on tuberculosis treatment outcomes:a systematic review. BMC Med, 2011, 9(81):1-15.
27. 何权瀛, 张波.应高度重视免疫功能低下患者的肺部感染.中华结核和呼吸杂志, 2012, 33(10):721-722.
28. Nijland HM, Ruslami R, Stalenhoef JE, et al. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis, 2006, 43(7):848-854.
29. Lenjisa J. Assessment of Tuberculosis Retreatment Case Rate and Its Treatment Outcomes at Adama Hospital Medical College, East Showa, Ethiopia. J Steroids Horm Sci, 2015, 06(1):1-6.
30. Jones-Ló pez EC, Ayakaka I, Levin J, et al. Effectiveness of the standard WHO recommended retreatment regimen (category II) for tuberculosis in Kampala, Uganda:a prospective cohort study. PLoS Med, 2011, 8(3):e1000427.
31. Mpagama SG, Lekule IA, Mbuya AW, et al. The Influence of Mining and Human Immunodeficiency Virus Infection Among Patients Admitted for Retreatment of Tuberculosis in Northern Tanzania. Am J Trop Med Hyg, 2015, 93(2):212-215.
32. Matthys F, Rigouts L, Sizaire V, et al. Outcomes after chemotherapy with WHO category II regimen in a population with high prevalence of drug resistant tuberculosis. PLoS One, 2009, 4(11):e7954.
33. Kritski AL, Rodrigues De Jesus LS, Andrade MK, et al. Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest, 1997, 111(5):1162-1167.
34. Espinal MA, Kim SJ, Suarez PG, et al. Standard short-course chemotherapy for drug-resistant tuberculosis:treatment outcomes in 6 countries. JAMA, 2000, 283(19):2537-2545.
35. He GX, Xie YG, Wang LX, et al. Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment. PLoS One, 2010, 5(5):e10799.
36. Green E, Obi CL, Nchabeleng M, et al. Drug-susceptibility patterns of Mycobacterium tuberculosis in Mpumalanga province, South Africa:possible guiding design of retreatment regimen. J Health Popul Nutr, 2010, 28(1):7-13.
37. Mak A, Thomas A, Del Granado M, et al. Influence of multidrug resistance on tuberculosis treatment outcomes with standardized regimens. Am J Respir Crit Care Med, 2008, 178(3):306-312.
38. Ogbera AO, Kapur A, Abdur-Razzaq H, et al. Clinical profile of diabetes mellitus in tuberculosis. BMJ Open Diabetes Res Care, 2015, 3(1):e000112.
39. Tabarsi P, Chitsaz E, Tabatabaei V, et al. Revised Category II regimen as an alternative strategy for retreatment of Category I regimen failure and irregular treatment cases. Am J Ther, 2011, 18(5):343-349.
40. Takarinda KC, Harries AD, Srinath S, et al. Treatment outcomes of adult patients with recurrent tuberculosis in relation to HIV status in Zimbabwe:a retrospective record review. BMC Public Health, 2011, 12(12):124.
41. World Health Organization. Global Tuberculosis Report 2013, Geneva:WHO.
42. Han LL, Sloutsky A, Canales R, et al. Acquisition of drug resistance in multidrug-resistant Mycobacterium tuberculosis during directly observed empiric retreatment with standardized regimens. Int J Tuberc Lung Dis, 2005, 9(7):818-821.
43. Faustini A, Hall AJ, Perucci CA. Risk factors for multidrug resistant tuberculosis in Europe:a systematic review. Thorax, 2006, 61(2):158-163.
44. Denholm J. The most recent report from the World Health Organization found that, worldwide, approximately 5% of new tuberculosis cases are caused by multidrug-resistant strains (MDR TB). J Travel Med, 2010, 17(3):216.
45. Pieroni M, Tipparaju SK, Lun S, et al. Pyrido[1, 2-a]benzimidazole-based agents active against tuberculosis(TB), multidrug-resistant(MDR) TB and extensively drug-resistant(XDR) TB. ChemMedChem, 2011, 6(2):334-342.
46. Prammananan T, Chaiprasert A, Leechawengwongs M. In vitro activity of linezolid against multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant (XDR)-TB isolates. Int J Antimicrob Agents, 2009, 33(2):190-191.

Chinese Journal of Evidence-Based Medicine

Risk Factors of Retreatment Pulmonary Tuberculosis Patients with Unfavorable Treatment Outcome in China: A Meta-analysis

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