Factors Associated with Mortality among Multidrug Resistant Tuberculosis MDR/RR-TB Patients in Democratic Republic of Congo

Murhula Innocent Kashongwe1,2, Leopoldine Mbulula2, Pierre Umba2, Francois Bompeka Lepira3,
Michel Kaswa4, Zacharie Munogolo Kashongwe1


1Lung disease Unit, Department of Internal medicine, Faculty of Medicine, University of Kinshasa Hospital, University of
Kinshasa, Kinshasa, Democratic Republic of Congo
2Centre d’excellence Damien (CEDA), Action Damien, DR Congo
3Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, University of Kinshasa Hospital, University of
Kinshasa, Kinshasa, Democratic Republic of Congo
4National Tuberculosis Program of DR Congo (NTP), DR Congo


Abstract

Background: Tuberculosis remains a very common infectious disease in Democratic Republic of Congo (DRC). The resistance to drugs worsens the prognosis and the outcome of patients affected tuberculosis and increase their mortality. Objective: To identify factors associated with death among Multidrugs resistant tuberculosis (MDR/RR TB) patients referred to the referential hospital, Centre d’Excellence Damien (CEDA). Materials and Methods: A retrospective cohort study of patients attending health care to the Center CEDA, a referral center for management of MDR/RR-TB in DR Congo. This study included all MDR/RR-TB patients referred from February 1st, 2015 to February 29th, 2017. A multivariate COX regression was performed to identify factors associated with mortality in the target population. Kaplan Meier method described the survival of patients and the comparison of curves was performed by the test of log Rank. Results: 199 patients were included in our
study. Male gender was predominant with a sex ratio of 1.3. The mean age of patients was 35.8 ± 13.9 years. Among them, 18 (15.1%) were died. The major
complications were Chronicles pulmonary Heart failure (p = 0.035), Chronic respiratory insufficiency (p = 0.004), depression (p = 0.044), undernutrition
(p = 0.033), alcohol addiction (p = 0.006) and high smoking (p = 0.019). In multivariated analysis, factors associated to the death were alcohol addiction
(HRa = 12.64, 95% CI 2.36 – 14.55, p = 0.003), asthenia (HRa = 4.75, 95% CI 1.56 – 14.50, p < 0.001), pulmonary consolidation (HRa = 10.01 95% CI 2.34 –
12.86, p = 0.02), some chest X-ray abnormalities such as signs of pulmonary fibrosis (HR = 4.7, 95% CI 2.78 – 28.94, p = 0.002) and the Chronic respiratory
insufficiency (HRa = 3.77, 95% CI 1.37 – 10.43, p = 0.010). Conclusion: The present retrospective cohort study revealed that structural and functional pulmonary alteration emerged as the main factors associated with mortality among MDR/RR TB patients in Kinshasa. National Tuberculosis Programs should take into account those parameters while defining mortality reduction strategy.

Keywords

MDR/RR-TB, Mortality, Kinshasa, Factors

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