Determinación de predictores de mortalidad en pacientes con tuberculosis (TB)

Angie Juliette Barreto Sánchez; Javier Leonardo Mancini Castrillón; Juan Diego Londoño Cabrera; Leonardo Vera Yara; María Paula Peña Ovalle; Jorge Andrés Ramos Castañeda

Determinación de predictores de mortalidad en pacientes con tuberculosis (TB)

Angie Juliette Barreto Sánchez, Javier Leonardo Mancini Castrillón, Juan Diego Londoño Cabrera, Leonardo Vera Yara, María Paula Peña Ovalle, Jorge Andrés Ramos Castañeda

Resumen

Antecedentes: La tuberculosis es un importante problema de salud pública, sin embargo, no hay investigaciones recientes que documenten factores de riesgo y la relación de estos con la mortalidad y la progresión a formas de tuberculosis resistente.

Objetivos: El presente estudio tiene como objetivos analizar la importancia de los factores de riesgo en la progresión hacia una tuberculosis resistente y determinar si estos mismos son predictores de mortalidad.

Metodología: Se emplearon estudios que determinaron factores predictores de mortalidad por TB (tuberculosis) resistente. Se consultaron las bases MEDLINE, CENTRAL, EBSCO, LILACS y EMBASE, se evaluaron 1152 artículos de los cuales seleccionamos 23 que cumplen con los criterios de selección.

Resultados: Se incluyeron 23 artículos en la revisión. 74% incluyeron pacientes con HIV. La mortalidad mostró heterogeneidad alta en los diferentes estudios revisados y frente a los factores predictores de mortalidad, que incluyen tipo de resistencia, características propias del individuo (modificables y no modificables) y los factores determinados por la enfermedad.

Conclusión: Los predictores de mortalidad en adultos con tuberculosis resistente son los patrones de resistencia, la edad mayor, la coinfección con HIV, el compromiso extrapulmonar, historia de tratamiento previo de la enfermedad, bajo índice de masa corporal o desnutrición, alcoholismo, tabaquismo, cavitación documentada por TAC y comorbilidades.

Palabras clave

uberculosis, factores de riesgo y predictores de morbilidad.

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Referencias

Centro para el control y la prevencion de enfermedades (CDC). Enfermedad de tuberculosis (TB): Síntomas y factores de riesgo. [Fecha de consulta: 1 de enero de 2019]. Disponible en: https://bit.ly/3eipZ10

Feng JY, Su WJ, Chiu YC, Huang SF, Lin YY, Huang RM, et al. Initial presentations predict mortality in pulmonary tuberculosis patients - a prospective observational study. PLoS One. 2011; 6(9): e23715. https://doi.org/10.1371/journal.pone.0023715

World Health Organization (WHO). Global Tuberculosis Report 2018. [Fecha de consulta 25 de enero de 2019]. Disponible en: https://bit.ly/2Vt2wRY

Adamu AL, Gadanya MA, Abubakar IS, Jibo AM, Bell MM, Gajida AU, et al. High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study. BMC Infect Dis. 2017;17(1):170 https://doi.org/10.1186/s12879-017-2249-4

Gunther G. Multidrug-resistant and extensively drug-resistant tuberculosis: a review of current concepts and future challenges. Clin med (Lond). 2014;14:279-85. https://doi.org/10.7861/clinmedicine.14-3-279

Bei C, Fu M, Zhang Y, Xie H, Yin K, Liu Y, et al. Mortality and associated factors of patients with extensive drug-resistant tuberculosis: an emerging public health crisis in China. BMC Inf Dis. 2018;18:261. https://doi.org/10.1186/s12879-018-3169-7

Georghiou SB, Seifert M, Catanzaro DG, Garfein RS, Rodwell TC. Increased Tuberculosis Patient Mortality Associated with Mycobacterium tuberculosis Mutations Conferring Resistance to Second-Line Antituberculous Drugs. J Cli Microbiol. 2017; 55:1928-37. https://doi.org/10.1128/JCM.00152-17

Maitra A, Kamil TK, Shaik M, Danquah CA, Chrzastek A, Bhakta S. Early diagnosis and effective treatment regimens are the keys to tackle antimicrobial resistance in tuberculosis (TB): A report from Euroscicon's international TB Summit 2016. Virulence. 2017;8:1005-24. https://doi.org/10.1080/21505594.2016.1256536

Jeon DS, Shin DO, Park SK, Seo JE, Seo HS, Cho YS, et al. Treatment outcome and mortality among patients with multidrug-resistant tuberculosis in tuberculosis hospitals of the public sector. J Korean Med Sci. 2011;26: 33-41.

https://doi.org/10.3346/jkms.2011.26.1.33

Kurbatova EV, Taylor A, Gammino VM, Bayona J, Becerra M, Danilovitz M, et al. Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects. Tuberculosis (Edinb). 2012; 92: 397–403. https://doi.org/10.1016/j.tube.2012.06.003

Duraisamy K, Mrithyunjayan S, Ghosh S, Achuthan S, Balakrishnan S, Subramoniapillai J, et al. Does Alcohol consumption during multidrug-resistant tuberculosis treatment affect outcome?. A population-based study in Kerala, India. Ann Am Thorac Soc. 2014;11:712-8. https://doi.org/10.1513/AnnalsATS.201312-447OC

Isaakidis P, Cox HS, Varghese B, Montaldo C, Silva E, Mansoor H, et al. Ambulatory multi-drug resistant tuberculosis treatment outcomes in a cohort of HIV-infected patients in a slum setting in Mumbai, India. PLoS One. 2011;6: e28066. https://doi.org/10.1371/journal.pone.0028066

Low S, Ang LW, Cutter J, James L, Chee CB, Wang YT, et al. Mortality among tuberculosis patients on treatment in Singapore. Int J Tuberc Lung Dis. 2009;13:328-34.

Lubart E, Lidgi M, Leibovitz A, Rabinovitz C, Segal R. Mortality of patients hospitalized for active tuberculosis in Israel. Isr Med Assoc J. 2007;9:870-3.

Bartu V, Kopecka E, Havelkova M. Factors associated with multidrug-resistant tuberculosis: comparison of patients born inside and outside of the Czech Republic. J Int Med Res. 2010; 38: 1156-63. https://doi.org/10.1177/147323001003800345

Flament-Saillour M, Robert J, Jarlier V, Grosset J. Outcome of multi-drug-resistant tuberculosis in France: a nationwide case-control study. Am J Respir Crit Care Med. 1999;160: 587-93. https://doi.org/10.1164/ajrccm.160.2.9901012

Leimane V, Riekstina V, Holtz TH, Zarovska E, Skripconoka V, Thorpe LE, et al. Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study. Lancet. 2005;365:318-26. https://doi.org/10.1016/S0140-6736(05)17786-1

Hannah HA, Miramontes R, Gandhi NR. Sociodemographic and Clinical Risk Factors Associated With Tuberculosis Mortality in the United States, 2009-2013. Public Health Rep. 2017;132:366-75. https://doi.org/10.1177/0033354917698117

Garcia-Garcia ML, Jimenez-Corona ME, Ponce-de-Leon A, Jimenez-Corona A, Palacios-Martinez M, Balandrano-Campos S, et al. Mycobacterium tuberculosis drug resistance in a suburban community in southern Mexico. Int J Tuberc Lung Dis. 2000;4:168-70.

Gayoso R, Dalcolmo M, Braga JU, Barreira D. Predictors of mortality in multidrug-resistant tuberculosis patients from Brazilian reference centers, 2005 to 2012. Braz J Infect Dis. 2018;22:305-10. https://doi.org/10.1016/j.bjid.2018.07.002

Park MM, Davis AL, Schluger NW, Cohen H, Rom WN. Outcome of MDR-TB patients, 1983-1993. Prolonged survival with appropriate therapy. Am J Respir Crit Care Med. 1996;153:317-24. https://doi.org/10.1164/ajrccm.153.1.8542137

Franzetti F, Gori A, Lemoli E, Meraviglia P, Mainini F, Quirino T, et al. Outcome of multidrug-resistant tuberculosis in human immunodeficiency virus-infected patients. Clin Infect Dis. 1999;29:553-60. https://doi.org/10.1086/598633

Chung-Delgado K, Revilla-Montag A, Guillen-Bravo S, Bernabe-Ortiz A. Weight variation over time and its relevance among multidrug-resistant tuberculosis patients. Int J Infect Dis. 2014;23:20-4. https://doi.org/10.1016/j.ijid.2014.01.001

Manosuthi W, Chottanapand S, Thongyen S, Chaovavanich A, Sungkanuparph S. Survival rate and risk factors of mortality among HIV/tuberculosis-coinfected patients with and without antiretroviral therapy. J Acquir Immune Defic Syndr. 2006;43:42-6. https://doi.org/10.1097/01.qai.0000230521.86964.86

Kritski AL, Rodrigues de Jesus LS, Andrade MK, Werneck-Barroso E, Vieira MA, Haffner A, et al. Retreatment tuberculosis cases. Factors associated with drug resistance and adverse outcomes. Chest. 1997;111:1162-7. https://doi.org/10.1378/chest.111.5.1162

Sharma SK, Mohan A. Multidrug-resistant tuberculosis. Indian J Med Res. 2004;120:354-76.

Drobniewski F, Eltringham I, Graham C, Magee JG, Smith EG, Watt B. A national study of clinical and laboratory factors affecting the survival of patients with multiple drug resistant tuberculosis in the UK. Thorax. 2002;57:810-6. https://doi.org/10.1136/thorax.57.9.810

Breathnach AS, de Ruiter A, Holdsworth GM, Batema NT, O´Sullivan DG, Rees PJ, et al. An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital. J Hosp Infect. 1998;39:111-7.

Raviglione MC, Smith IM. XDR tuberculosis--implications for global public health. N Engl J Med. 2007;356:656-59. https://doi.org/10.1056/NEJMp068273

Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM. Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One. 2009;4: e6914. https://doi.org/10.1371/journal.pone.0006914

Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, Bayona J, et al. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Med. 2012;9: e1001300. https://doi.org/10.1371/journal.pmed.1001300

Mitnick CD, Franke MF, Rich ML, Alcantara FA, Appleton SC, Atwodd SS, et al. Aggressive regimens for multidrug-resistant tuberculosis decrease all-cause mortality. PLoS One. 2013;8: e58664. https://doi.org/10.1371/journal.pone.0058664

Dheda K, Gumbo T, Gandhi NR, Murray M, Theron G, Udwadia Zarir, et al. Global control of tuberculosis: from extensively drug-resistant to untreatable tuberculosis. Lancet Respir Med. 2014;2:321-38. https://doi.org/10.1016/S2213-2600(14)70031-1