Meta-analysis And Risk Score Of Risk Factors For The Treatment Failure Of Retreated Pulmonary Tuberculosis Patients In China

Objective 1 Risk factors of retreatment pulmonary tuberculosis patients with treatment failure in China: A Meta-analysisTo systematically review the risk factors of retreatment pulmonary tuberculosis with treatment failure.2 Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: An optimized prediction modelTo identify the influence factors for the failure of retreated pulmonary tuberculosis(PTB)patients through analysis of the success and the failure patients,and assess the risk of influence factors that lead to treatment failure,aim to providing scientific theoretical basis for developing of preventive measures in the future.Methods 1 Risk factors of retreatment pulmonary tuberculosis patients with treatment failure in China: A Meta-analysisWe electronically searched databases including CNKI,VIP,CBM and WanFang.Date from inception to November 15 th 2015,to collect studies about the risk factors of retreatment pulmonary tuberculosis patients with treatment failure.2 Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: An optimized prediction modelThe total 395 patients were selected in the cohort who participated in the study of retreatment based on the inclusion and exclusion criteria and received treatment from July 2009 to May 2011.Univariable and multivariable logistic regression were used to evaluate the association between treatment outcome and socio-demographic as well as clinical factors.Improving Framingham risk model was used to calculate risk score of risk factors that influencing treatment failure for retreated pulmonary tuberculosis patients,which can used to assess the risk of retreatment failure.231 retreated PTB patients who received study of high dose for validated regimen between January 2013 and December 2015 as a testing cohort in China,which was used to verify the value of prediction model for failure of retreatment tuberculosis.Results 1 Risk factors of retreatment pulmonary tuberculosis patients with treatment failure in China: A Meta-analysisA total of 13 studies were included.The results of meta-analysis showed that significant association was found between retreatment pulmonary tuberculosis cases with treatment failure and such factors as the standard retreatment regimen,drug-resistance,multi-drug resistance,status of cavities,TB-diabetes mellitus and high sputum smear load>2+ in univariate-analysis,respectively.But,in multivariate-analysis,only TB diabetes mellitus was an independent risk factor for retreatment pulmonary tuberculosis cases with treatment failure.2 Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: An optimized prediction modelAmong 395 retreated smear-positive pulmonary tuberculosis patients,99(25.1%)of them in the treatment failure group and 296(74.9%)in treatment success group.The multivariate Logistic analysis showed that independent risk factors associated with treatment failure included drug resistance,standard regimen,positive culture result after two months of treatment,BMI<18.5,low education level(high school,middle school or primary school),place where first medicine was taken(other),long duration of previous treatment(>6 months)and other type of retreatment(return,lost).A risk score derived from a Logistic regression model containing these independent predictors had a good predictive accuracy for treatment failure [Area under the curve(AUC)= 0.774,95%CI: 0.715–0.883].The testing cohort was substituted into risk score model,the results show that the sensitivity of treatment failure is 60.5%,the area under curve also had adequate performance in testing the sample [AUC=0.781,95%CI: 0.695-0.866].Conclusion 1 Risk factors of retreatment pulmonary tuberculosis patients with treatment failure in China: A Meta-analysisCurrent evidence shows that TB-diabetes mellitus,standard retreatment regimen,drug-resistance,multi-drug resistance,status of cavities and high sputum smear load >2+ are considered to be the risk factors for retreatment pulmonary tuberculosis cases with treatment failure.Especially,for patients with diabetes,the importance of management needs to be reinforced to reduce the failure rate in the retreatment of pulmonary tuberculosis.2 Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: An optimized prediction modelInfluence factors of treatment outcome for retreatment pulmonary tuberculosis patients include BMI,education level,place where first medicine was taken,type of retreatment,drug susceptibility result,treatment regimen,number of previous treatment and positive culture result after two months of treatment.A retreated PTB treatment failure risk score can improve early diagnosis of PTB failure particularly in settings with standard regimen.