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A systematic review of risk factors for mortality among tuberculosis patients in South Africa

BACKGROUND: Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. METHODS: We conducted a systematic review of TB research articles published between 2010 and 2...

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Autores principales: Nicholson, Tamaryn J, Hoddinott, Graeme, Seddon, James A, Claassens, Mareli M, van der Zalm, Marieke M, Lopez, Elisa, Bock, Peter, Caldwell, Judy, Da Costa, Dawood, de Vaal, Celeste, Dunbar, Rory, Du Preez, Karen, Hesseling, Anneke C, Joseph, Kay, Kriel, Ebrahim, Loveday, Marian, Marx, Florian M, Meehan, Sue-Ann, Purchase, Susan, Naidoo, Kogieleum, Naidoo, Lenny, Solomon-Da Costa, Fadelah, Sloot, Rosa, Osman, Muhammad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9946877/
https://www.ncbi.nlm.nih.gov/pubmed/36814335
http://dx.doi.org/10.1186/s13643-023-02175-8
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author Nicholson, Tamaryn J
Hoddinott, Graeme
Seddon, James A
Claassens, Mareli M
van der Zalm, Marieke M
Lopez, Elisa
Bock, Peter
Caldwell, Judy
Da Costa, Dawood
de Vaal, Celeste
Dunbar, Rory
Du Preez, Karen
Hesseling, Anneke C
Joseph, Kay
Kriel, Ebrahim
Loveday, Marian
Marx, Florian M
Meehan, Sue-Ann
Purchase, Susan
Naidoo, Kogieleum
Naidoo, Lenny
Solomon-Da Costa, Fadelah
Sloot, Rosa
Osman, Muhammad
author_facet Nicholson, Tamaryn J
Hoddinott, Graeme
Seddon, James A
Claassens, Mareli M
van der Zalm, Marieke M
Lopez, Elisa
Bock, Peter
Caldwell, Judy
Da Costa, Dawood
de Vaal, Celeste
Dunbar, Rory
Du Preez, Karen
Hesseling, Anneke C
Joseph, Kay
Kriel, Ebrahim
Loveday, Marian
Marx, Florian M
Meehan, Sue-Ann
Purchase, Susan
Naidoo, Kogieleum
Naidoo, Lenny
Solomon-Da Costa, Fadelah
Sloot, Rosa
Osman, Muhammad
author_sort Nicholson, Tamaryn J
collection PubMed
description BACKGROUND: Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. METHODS: We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. RESULTS: We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. CONCLUSIONS: In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. SYSTEMATIC REVIEW REGISTRATION: The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13643-023-02175-8.
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spelling pubmed-99468772023-02-23 A systematic review of risk factors for mortality among tuberculosis patients in South Africa Nicholson, Tamaryn J Hoddinott, Graeme Seddon, James A Claassens, Mareli M van der Zalm, Marieke M Lopez, Elisa Bock, Peter Caldwell, Judy Da Costa, Dawood de Vaal, Celeste Dunbar, Rory Du Preez, Karen Hesseling, Anneke C Joseph, Kay Kriel, Ebrahim Loveday, Marian Marx, Florian M Meehan, Sue-Ann Purchase, Susan Naidoo, Kogieleum Naidoo, Lenny Solomon-Da Costa, Fadelah Sloot, Rosa Osman, Muhammad Syst Rev Research BACKGROUND: Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. METHODS: We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. RESULTS: We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. CONCLUSIONS: In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. SYSTEMATIC REVIEW REGISTRATION: The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13643-023-02175-8. BioMed Central 2023-02-23 /pmc/articles/PMC9946877/ /pubmed/36814335 http://dx.doi.org/10.1186/s13643-023-02175-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Nicholson, Tamaryn J
Hoddinott, Graeme
Seddon, James A
Claassens, Mareli M
van der Zalm, Marieke M
Lopez, Elisa
Bock, Peter
Caldwell, Judy
Da Costa, Dawood
de Vaal, Celeste
Dunbar, Rory
Du Preez, Karen
Hesseling, Anneke C
Joseph, Kay
Kriel, Ebrahim
Loveday, Marian
Marx, Florian M
Meehan, Sue-Ann
Purchase, Susan
Naidoo, Kogieleum
Naidoo, Lenny
Solomon-Da Costa, Fadelah
Sloot, Rosa
Osman, Muhammad
A systematic review of risk factors for mortality among tuberculosis patients in South Africa
title A systematic review of risk factors for mortality among tuberculosis patients in South Africa
title_full A systematic review of risk factors for mortality among tuberculosis patients in South Africa
title_fullStr A systematic review of risk factors for mortality among tuberculosis patients in South Africa
title_full_unstemmed A systematic review of risk factors for mortality among tuberculosis patients in South Africa
title_short A systematic review of risk factors for mortality among tuberculosis patients in South Africa
title_sort systematic review of risk factors for mortality among tuberculosis patients in south africa
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9946877/
https://www.ncbi.nlm.nih.gov/pubmed/36814335
http://dx.doi.org/10.1186/s13643-023-02175-8
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