Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia.
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 vu...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0227291 |
| _version_ | 1818405188138958848 |
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| author | Sílvia Brugueras Vinicio-Israel Molina Xavier Casas Yoel-Domingo González Nuria Forcada Dora Romero Anna Rodés Maria-Neus Altet José Maldonado Mario Martin-Sánchez Joan A Caylà Àngels Orcau Cristina Rius Joan-Pau Millet |
| author_facet | Sílvia Brugueras Vinicio-Israel Molina Xavier Casas Yoel-Domingo González Nuria Forcada Dora Romero Anna Rodés Maria-Neus Altet José Maldonado Mario Martin-Sánchez Joan A Caylà Àngels Orcau Cristina Rius Joan-Pau Millet |
| author_sort | Sílvia Brugueras |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T08:52:04Z |
| format | Article |
| id | doaj.art-95fb32c77fe941ceb82eb2c169b7db4c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-14T08:52:04Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-95fb32c77fe941ceb82eb2c169b7db4c2022-12-21T23:09:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01151e022729110.1371/journal.pone.0227291Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia.Sílvia BruguerasVinicio-Israel MolinaXavier CasasYoel-Domingo GonzálezNuria ForcadaDora RomeroAnna RodésMaria-Neus AltetJosé MaldonadoMario Martin-SánchezJoan A CaylàÀngels OrcauCristina RiusJoan-Pau MilletBACKGROUND: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.https://doi.org/10.1371/journal.pone.0227291 |
| spellingShingle | Sílvia Brugueras Vinicio-Israel Molina Xavier Casas Yoel-Domingo González Nuria Forcada Dora Romero Anna Rodés Maria-Neus Altet José Maldonado Mario Martin-Sánchez Joan A Caylà Àngels Orcau Cristina Rius Joan-Pau Millet Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. PLoS ONE |
| title | Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. |
| title_full | Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. |
| title_fullStr | Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. |
| title_full_unstemmed | Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. |
| title_short | Tuberculosis recurrences and predictive factors in a vulnerable population in Catalonia. |
| title_sort | tuberculosis recurrences and predictive factors in a vulnerable population in catalonia |
| url | https://doi.org/10.1371/journal.pone.0227291 |
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