Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.

<h4>Background</h4>Even though the lives of millions have been saved in the past decades, the mortality rate in patients with drug-resistant tuberculosis is still high. Different factors are associated with this mortality. However, there is no comprehensive global report addressing these...

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Autores principales:	Ayinalem Alemu, Zebenay Workneh Bitew, Teshager Worku, Dinka Fikadu Gamtesa, Animut Alebel
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/78a0c469c68b4be3813b730f12c06c95
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spelling	oai:doaj.org-article:78a0c469c68b4be3813b730f12c06c952021-12-02T20:09:53ZPredictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.1932-620310.1371/journal.pone.0253848https://doaj.org/article/78a0c469c68b4be3813b730f12c06c952021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253848https://doaj.org/toc/1932-6203<h4>Background</h4>Even though the lives of millions have been saved in the past decades, the mortality rate in patients with drug-resistant tuberculosis is still high. Different factors are associated with this mortality. However, there is no comprehensive global report addressing these risk factors. This study aimed to determine the predictors of mortality using data generated at the global level.<h4>Methods</h4>We systematically searched five electronic major databases (PubMed/Medline, CINAHL, EMBASE, Scopus, Web of Science), and other sources (Google Scholar, Google). We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of included articles. Heterogeneity assessment was conducted using the forest plot and I2 heterogeneity test. Data were analyzed using STATA Version 15. The pooled hazard ratio, risk ratio, and odd's ratio were estimated along with their 95% CIs.<h4>Result</h4>After reviewing 640 articles, 49 studies met the inclusion criteria and were included in the final analysis. The predictors of mortality were; being male (HR = 1.25,95%CI;1.08,1.41,I2;30.5%), older age (HR = 2.13, 95%CI;1.64,2.62,I2;59.0%,RR = 1.40,95%CI; 1.26, 1.53, I2; 48.4%) including a 1 year increase in age (HR = 1.01, 95%CI;1.00,1.03,I2;73.0%), undernutrition (HR = 1.62,95%CI;1.28,1.97,I2;87.2%, RR = 3.13, 95% CI; 2.17,4.09, I2;0.0%), presence of any type of co-morbidity (HR = 1.92,95%CI;1.50-2.33,I2;61.4%, RR = 1.61, 95%CI;1.29, 1.93,I2;0.0%), having diabetes (HR = 1.74, 95%CI; 1.24,2.24, I2;37.3%, RR = 1.60, 95%CI;1.13,2.07, I2;0.0%), HIV co-infection (HR = 2.15, 95%CI;1.69,2.61, I2; 48.2%, RR = 1.49, 95%CI;1.27,1.72, I2;19.5%), TB history (HR = 1.30,95%CI;1.06,1.54, I2;64.6%), previous second-line anti-TB treatment (HR = 2.52, 95% CI;2.15,2.88, I2;0.0%), being smear positive at the baseline (HR = 1.45, 95%CI;1.14,1.76, I2;49.2%, RR = 1.58,95%CI;1.46,1.69, I2;48.7%), having XDR-TB (HR = 2.01, 95%CI;1.50,2.52, I2;60.8%, RR = 2.44, 95%CI;2.16,2.73,I2;46.1%), and any type of clinical complication (HR = 2.98, 95%CI; 2.32, 3.64, I2; 69.9%). There are differences and overlaps of predictors of mortality across different drug-resistance categories. The common predictors of mortality among different drug-resistance categories include; older age, presence of any type of co-morbidity, and undernutrition.<h4>Conclusion</h4>Different patient-related demographic (male sex, older age), and clinical factors (undernutrition, HIV co-infection, co-morbidity, diabetes, clinical complications, TB history, previous second-line anti-TB treatment, smear-positive TB, and XDR-TB) were the predictors of mortality in patients with drug-resistant tuberculosis. The findings would be an important input to the global community to take important measures.Ayinalem AlemuZebenay Workneh BitewTeshager WorkuDinka Fikadu GamtesaAnimut AlebelPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253848 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ayinalem Alemu Zebenay Workneh Bitew Teshager Worku Dinka Fikadu Gamtesa Animut Alebel Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.
description	<h4>Background</h4>Even though the lives of millions have been saved in the past decades, the mortality rate in patients with drug-resistant tuberculosis is still high. Different factors are associated with this mortality. However, there is no comprehensive global report addressing these risk factors. This study aimed to determine the predictors of mortality using data generated at the global level.<h4>Methods</h4>We systematically searched five electronic major databases (PubMed/Medline, CINAHL, EMBASE, Scopus, Web of Science), and other sources (Google Scholar, Google). We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of included articles. Heterogeneity assessment was conducted using the forest plot and I2 heterogeneity test. Data were analyzed using STATA Version 15. The pooled hazard ratio, risk ratio, and odd's ratio were estimated along with their 95% CIs.<h4>Result</h4>After reviewing 640 articles, 49 studies met the inclusion criteria and were included in the final analysis. The predictors of mortality were; being male (HR = 1.25,95%CI;1.08,1.41,I2;30.5%), older age (HR = 2.13, 95%CI;1.64,2.62,I2;59.0%,RR = 1.40,95%CI; 1.26, 1.53, I2; 48.4%) including a 1 year increase in age (HR = 1.01, 95%CI;1.00,1.03,I2;73.0%), undernutrition (HR = 1.62,95%CI;1.28,1.97,I2;87.2%, RR = 3.13, 95% CI; 2.17,4.09, I2;0.0%), presence of any type of co-morbidity (HR = 1.92,95%CI;1.50-2.33,I2;61.4%, RR = 1.61, 95%CI;1.29, 1.93,I2;0.0%), having diabetes (HR = 1.74, 95%CI; 1.24,2.24, I2;37.3%, RR = 1.60, 95%CI;1.13,2.07, I2;0.0%), HIV co-infection (HR = 2.15, 95%CI;1.69,2.61, I2; 48.2%, RR = 1.49, 95%CI;1.27,1.72, I2;19.5%), TB history (HR = 1.30,95%CI;1.06,1.54, I2;64.6%), previous second-line anti-TB treatment (HR = 2.52, 95% CI;2.15,2.88, I2;0.0%), being smear positive at the baseline (HR = 1.45, 95%CI;1.14,1.76, I2;49.2%, RR = 1.58,95%CI;1.46,1.69, I2;48.7%), having XDR-TB (HR = 2.01, 95%CI;1.50,2.52, I2;60.8%, RR = 2.44, 95%CI;2.16,2.73,I2;46.1%), and any type of clinical complication (HR = 2.98, 95%CI; 2.32, 3.64, I2; 69.9%). There are differences and overlaps of predictors of mortality across different drug-resistance categories. The common predictors of mortality among different drug-resistance categories include; older age, presence of any type of co-morbidity, and undernutrition.<h4>Conclusion</h4>Different patient-related demographic (male sex, older age), and clinical factors (undernutrition, HIV co-infection, co-morbidity, diabetes, clinical complications, TB history, previous second-line anti-TB treatment, smear-positive TB, and XDR-TB) were the predictors of mortality in patients with drug-resistant tuberculosis. The findings would be an important input to the global community to take important measures.
format	article
author	Ayinalem Alemu Zebenay Workneh Bitew Teshager Worku Dinka Fikadu Gamtesa Animut Alebel
author_facet	Ayinalem Alemu Zebenay Workneh Bitew Teshager Worku Dinka Fikadu Gamtesa Animut Alebel
author_sort	Ayinalem Alemu
title	Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.
title_short	Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.
title_full	Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.
title_fullStr	Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.
title_full_unstemmed	Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.
title_sort	predictors of mortality in patients with drug-resistant tuberculosis: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/78a0c469c68b4be3813b730f12c06c95
work_keys_str_mv	AT ayinalemalemu predictorsofmortalityinpatientswithdrugresistanttuberculosisasystematicreviewandmetaanalysis AT zebenayworknehbitew predictorsofmortalityinpatientswithdrugresistanttuberculosisasystematicreviewandmetaanalysis AT teshagerworku predictorsofmortalityinpatientswithdrugresistanttuberculosisasystematicreviewandmetaanalysis AT dinkafikadugamtesa predictorsofmortalityinpatientswithdrugresistanttuberculosisasystematicreviewandmetaanalysis AT animutalebel predictorsofmortalityinpatientswithdrugresistanttuberculosisasystematicreviewandmetaanalysis
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Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis.

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