Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia

Brugueras, Silvia; Molina, Vinicio-Israel; Casas, Xavier; González, Yoel-Domingo; Forcada, Núria; Romero, Dora; Rodés, Anna; Altet, Maria-Neus; Maldonado, José; Martin-Sánchez, Mario; Caylà i Busqueras, Joan A.; Orcau, Àngels; Rius, Cristina; Millet, Joan-Pau

doi:http://dx.doi.org/10.1371/journal.pone.0227291

Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia

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Brugueras S, Molina VI, Casas X, González YD, Forcada N, Romero D, Rodés A, Altet MN, Maldonado J, Martin-Sánchez M, Caylà JA, Orcau À, Rius C, Millet JP. Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. PLoS One. 2020; 15(1):e0227291. DOI: 10.1371/journal.pone.0227291

Abstract

Background: 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. Methods: 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). Results: 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). Conclusions: 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.