Analysis of the Results of Treatment of Destructive Pulmonary Tuberculosis and Possibilities of Prediction of its Outcomes

Authors: Sheifer YA* and Gelberg IS

Special Issue 1: Diagnosis & Treatment for Tuberculosis

Abstract

Purpose of the study: Analyze the results of chemotherapy for destructive forms of pulmonary tuberculosis and develop a method for predicting its outcomes. The analysis of long-term results of treatment was carried out in 296 patients with destructive pulmonary TB who were inpatient treatment at the health care institution Grodno Regional Clinical Center "Phthisiology". The design included a randomized, controlled, retrospective, prospective cohort study. In patients with persisting destruction of lung tissue, despite the achievement of abacillation by the end of the intensive phase of chemotherapy, a high proportion of ineffective treatment (28.6-57.4%), transition to fibro-cavernous tuberculosis (16.7-35.3%) was established, amplification of drug resistance, the emergence of widespread drug resistance of M. tuberculosis (up to 38.2%), which causes a decrease in the rate of successful treatment (up to 39.7%) and a high rate of deaths (21.4-33.8%). A method has been developed for predicting the preservation of decay cavities in patients with destructive pulmonary tuberculosis during chemotherapy, according to which the predictors are the clinical form of pulmonary tuberculosis, the number of cavities, the presence of alcohol dependence syndrome, and the duration of abacillation. Based on the results obtained, a regression equation was constructed to predict the possible preservation of decay cavities against the background of chemotherapy: Z = 6.456-4.907 * CF-3.682 * NC-2.169 * ADS-A, where: CF (clinical form) = 0 for infiltrative pulmonary TB in the decay phase; CF = 1 with cavernous; NC (number of decay cavities) = 0 in the presence of 1 decay cavity; NC = 1 in the presence of 2 cavities or more; ADS- alcohol dependence syndrome (0 - no sign, 1 - there is a sign); A = 0 Abacillation received within 3 months; A = 4.115 - 3-4 months; A = 5.189 - 5-6 months; A = 25.249 - in the absence of abacillation. The sensitivity of the method is 97.0%, the specificity is 80.6%. The method makes it possible to substantiate a differentiated approach to complex treatment with the timely use of surgical or collapse therapy methods.

Keywords: Destructive Tuberculosis; Prognosis; Predictors; Outcomes; Cohort; Multidrug Resistance of Mycobacterium Tuberculosis; Long-Term Results; Specificity; Sensitivity

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