| Literature DB >> 34767601 |
Atiqa Ambreen1,2, Sabira Tahseen3,4, Ahmad Wali4, Muhammad Jamil5, Syed Zeeshan Haider Naqvi2, Nauman Safdar6, Tehmina Mustafa4,7.
Abstract
The optimal duration of treatment in different forms of extrapulmonary tuberculosis (EPTB) is not clearly defined. This study aimed to identify predictors of slow clinical response and extended anti-TB treatment in EPTB patients. Socio-demographic, clinical, and microbiological characteristics of EPTB patients registered for anti-TB treatment at a tertiary care hospital, were analysed for identification of predictors of extended treatment. A total of 251 patients (137 lymphadenitis, and 114 pleuritis) were included in the analysis. Treatment was extended to more than 6 months in 58/251 (23%) patients. In the multivariate regression analysis, culture-positive EPTB (p = 0.007) [OR (95% CI) = 3.81 (1.43, 10.11)], history of diabetes (p = 0.014) [OR (95% CI) = 25.18 (1.94, 325.83)], smokeless tobacco use (p = 0.002) [OR (95% CI) = 17.69 (2.80, 111.72)], and slow regression of local signs and symptoms after 2 months of treatment (p < 0.001) [OR (95% CI) = 17.09 [(5.79, 50.39)] were seen to be significantly associated with treatment extension. Identification of predictors of extended treatment can help clinical decisions regarding optimal duration of treatment. Further studies are needed to identify subgroups of EPTB patients who can benefit from a shorter or longer treatment regimen.Entities:
Mesh:
Year: 2021 PMID: 34767601 PMCID: PMC8589173 DOI: 10.1371/journal.pone.0259801
Source DB: PubMed Journal: PLoS One ISSN: 1932-6203 Impact factor: 3.240
Fig 1Flow chart showing the participants included in the analysis.
LN: TB lymphadenitis, PF: TB pleuritis, EPTB: extrapulmonary tuberculosis, TB: tuberculosis, GDH: Gulab Devi Hospital, LTFUP: lost to follow-up, M: month.
Analysis of patient and disease related characteristics associated with prolonged treatment by univariable logistic regression model.
| Standard treatment (6M) n/N (%) | Extended Treatment n/N (%) | OR | 95% CI | p-value | |
|---|---|---|---|---|---|
|
| |||||
| > 21 years | 102/193 (53) | 22/58 (38) | 1.00 | ||
| ≤ 21 years | 91/193 (47) | 36/58 (62) | 1.83 | 1.00–3.34 | 0.048 |
|
| |||||
| Male | 106/193 (55) | 22/58 (38) | 1.00 | ||
| Female | 87/193 (45) | 36/58 (62) | 1.99 | 1.09–3.63 | 0.025 |
|
| |||||
| ≥ 18.5 | 77/135 (57) | 9/34 (26) | 1.00 | ||
| < 18.5 | 58/135 (43) | 25/34 (74) | 3.68 | 1.60–8.49 | 0.002 |
|
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| Level 2 (Upper Middle) | 3/166 (2) | 0/49 (0) | 1.00 | ||
| Level 3 (Lower Middle) | 64/166 (38) | 14/49 (29) | 0.00 | 0.00 | 0.999 |
| Level 4 (Upper Lower) | 99/166 (60) | 35/49 (71) | 0.61 | 0.30–1.24 | 0.176 |
|
| |||||
| No | 157/165 (95) | 42/49 (86) | 1.00 | ||
| Yes | 8/165 (5) | 7/49 (14) | 3.27 | 1.12–9.53 | 0.030 |
|
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| No | 147/165 (89) | 45/49 (92) | 1.00 | ||
| Yes | 18/165 (11) | 4/49 (8) | 0.72 | 0.23–2.25 | 0.580 |
|
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| ≤ 69 days | 105/190 (55) | 22/57 (39) | 1.00 | ||
| > 69 days | 85/190 (45) | 35/57(61) | 1.96 | 1.07–3.59 | 0.029 |
|
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| No | 165/166 (99) | 46/49 (94) | 1.00 | ||
| yes | 1/166 (1) | 3/49 (6) | 10.76 | 1.09–105.9 | 0.042 |
|
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| No | 186/190 (98) | 49/54 (91) | 1.00 | ||
| yes | 4/190 (2) | 5/54 (9) | 4.74 | 1.22–18.33 | 0.024 |
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| Level 1 | 27/155 (17) | 3/46 (7) | 1.00 | ||
| Level 2 or 3 | 128/155 (83) | 43/46 (93) | 3.02 | 0.87–10.46 | 0.081 |
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| Culture negative | 121/193 (53) | 25/58 (36) | 1.00 | ||
| Culture positive | 72/193 (47) | 37/58(64) | 2.21 | 1.22–4.02 | 0.009 |
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| Pleura | 101/193 (52) | 13/58 (22) | 1.00 | ||
| Lymph nodes | 92/193 (48) | 45/58 (78) | 3.80 | 1.92–7.49 | < 0.001 |
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| Unilateral | 89/92 (97) | 44/44(100) | 1 | ||
| Bilateral | 3/92 (3) | 0/44(0) | 0.00 | 0.00 | 0.999 |
| Matted/painful/discharging | |||||
| No | 35/72 (49) | 22/34 (65) | 1 | ||
| Yes | 37/72 (51) | 12/34 (35) | 0.51 | 0.22–1.19 | 0.123 |
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| No | 159/163 (98) | 42/ 43 (98) | 1 | ||
| Yes | 4/163 (2) | 1/43 (2) | 0.94 | 0.10–8.69 | 0.961 |
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| Responders | 142/193 (74) | 12/58 (21) | 1.00 | ||
| Partial responders | 51/193 (26) | 46/58 (79) | 10.67 | 5.24–21.73 | < 0.001 |
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| Any weight gain | 122/183 (67) | 31/56 (55) | 1.00 | ||
| No weight gain | 61/183 (33) | 25/56 (45) | 1.61 | 0.87–2.96 | 0.125 |
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| Any weight gain | 165/183 (90) | 42/53 (79) | 1.00 | ||
| No weight gain | 18/183 (10) | 11/53 (21) | 2.40 | 1.05–5.46 | 0.037 |
n: number of patients, N: total number of patients, OR: odds ratio, CI: confidence interval
None of the patients fell in upper (level 1) and lower (level 5) socioeconomic class
bHistory of hypertension, renal or liver disease, level 1
c: no problem, level 2 and 3
d: some or extreme problems.
Analysis of constitutional symptoms and duration of symptoms with prolonged treatment by univariable logistic regression model.
| Standard treatment (6M) n/N (%) | Extended Treatment n/N (%) | OR | 95% CI | p-value | ||
|---|---|---|---|---|---|---|
| Constitutional symptoms | ||||||
| No | 11/166 (7) | 5/49 (10) | 1.00 | |||
| yes | 155/166 (93) | 44/49 (90) | 0.62 | 0.20 | 1.89 | 0.405 |
| Duration of constitutional Symptoms | ||||||
| ≤ 8 weeks | 121/151 (80) | 25/43 (58) | 1.00 | |||
| > 8 weeks | 30/151 (20) | 18/43 (42) | 2.90 | 1.40 | 6.00 | 0.004 |
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| Fever | ||||||
| No | 27/163 (17) | 10/49 (20) | 1.00 | |||
| Yes | 136/163 (83) | 39/49 (80) | 0.77 | 0.34 | 1.73 | 0.535 |
| Duration of fever | ||||||
| ≤ 4 weeks | 79/130 (61) | 11/37 (30) | 1.00 | |||
| > 4 weeks | 51/130 (39) | 26/37 (70) | 3.66 | 1.66 | 8.05 | 0.001 |
| Weight loss | ||||||
| No | 87/161 (54) | 29/49 (59) | 1.00 | |||
| Yes | 74/161 (46) | 20/49 (41) | 0.81 | 0.42 | 1.55 | 0.526 |
| Duration of weight loss | ||||||
| ≤ 4 weeks | 41/67 (61) | 8/18 (44) | 1.00 | |||
| > 4 weeks | 26/67 (39) | 10/18 (56) | 1.97 | 0.68 | 5.64 | 0.206 |
| Appetite loss | ||||||
| No | 75/159 (47) | 27/45 (60) | 1.00 | |||
| Yes | 84/159 953) | 18/45 (40) | 0.59 | 0.30 | 1.16 | 0.131 |
| Duration of appetite loss | ||||||
| ≤ 4 weeks | 47/74 (64) | 7/15 (47) | 1.00 | |||
| > 4 weeks | 27/74 (36) | 8/15 (53) | 1.96 | 0.71 | 5.39 | 0.189 |
| Night sweats | ||||||
| No | 120/158 (76) | 37/46 (80) | 1.00 | |||
| Yes | 38/158 (24) | 9/46 (20) | 0.76 | 0.34 | 1.73 | 0.526 |
| Duration of night sweats | ||||||
| ≤ 4 weeks | 26/33 (79) | 5/9 (56) | 1.00 | |||
| > 4 weeks | 7/33 (21) | 4/9 (44) | 2.97 | 0.62 | 14.10 | 0.17 |
| Fatigue | ||||||
| No | 52/158 (33) | 15/47 (32) | 1 | |||
| Yes | 106/158 (67) | 32/47 (68) | 1.04 | 0.52 | 2.10 | 0.898 |
| Duration of fatigue | ||||||
| ≤ 4 weeks | 70/100 (70) | 16/29 (55) | 1.00 | |||
| > 4 weeks | 30/100 (30) | 13/29 (45) | 1.89 | 0.81 | 4.42 | 0.13 |
n: number of patients, N: total number of patients, OR: odds ratio, CI: confidence interval.
Multivariable logistic regression model for predictors of extended TB treatment.
| Unadjusted OR (95% CI) | p-value | Adjusted OR (95% CI) | p-value | |
|---|---|---|---|---|
|
| ||||
| > 21 years | 1.00 | 1.00 | ||
| ≤ 21 years | 1.83 (1.00–3.34) | 0.048 | 1.94 (0.68–5.51) | 0.213 |
|
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| Male | 1 | 1.00 | ||
| Female | 1.99 (1.09–3.63) | 0.025 | 2.28 (0.70–7.36) | 0.167 |
|
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| No | 1.00 | 1.00 | ||
| Yes | 3.27 (1.12–9.53) | 0.030 | 17.69 (2.80–111.72) | 0.002 |
|
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| Pleura | 1.00 | 1.00 | ||
| Lymph nodes | 3.80 (1.92–7.49) | < .001 | 1.50 (0.46–4.86) | 0.492 |
|
| ||||
| Culture negative | 1.00 | 1.00 | ||
| Culture positive | 2.21 (1.22–4.02) | 0.009 | 3.81 (1.43–10.11) | 0.007 |
| No | 1.00 | 1.00 | ||
| yes | 10.76 (1.09–105.9) | 0.042 | 4.74 (0.008–2757.77) | 0.687 |
|
| ||||
| No | 1.00 | 1.00 | ||
| yes | 4.74 (1.22–18.33) | 0.024 | 25.18 (1.94–325.83) | 0.014 |
|
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| ≤ 69 days | 1.00 | 1.00 | ||
| > 69 days | 1.96 (1.07–3.59) | 0.029 | 2.72 (0.98–7.49) | 0.053 |
|
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| Responders | 1.00 | 1.00 | ||
| Partial responders | 10.67 (5.24–21.73) | < 0.001 | 17.09 (5.79–50.39) | < 0.001 |
|
| ||||
| Any weight gain | 1.00 | 1.00 | ||
| No weight gain | 2.40 (1.05–5.46) | 0.037 | 0.61 (0.186–1.99) | 0.414 |
OR: odds ratio, CI: confidence interval, EPTB: extrapulmonary tuberculosis
aHistory of hypertension, renal or liver disease.