Factor analysis of medical risk factors for the development of an unfavorable outcome of tuberculosis treatment in comorbid patients
N.V. Bagisheva (1), A.V. Mordyk (1), I.A. Viktorova (1), K.I. Nesterova (1), V.V. Goltyapin (2), A.R. Aroyan (1), S.A. Rudenko (3), N.V. Shirinskaya (4)
1) Omsk State Medical University, Omsk, Russia;
2) Sobolev Institute of Mathematics, Siberian Branch of RAS (Omsk Branch), Omsk, Russia;
3) Clinical TB Dispensary № 4, Omsk, Russia;
4) Medical Information and Analytical Center, Omsk, Russia
Background. The problem of successful treatment of tuberculosis remains relevant, especially in patients with concomitant chronic obstructive pulmonary disease; in this connection, it seems relevant to identify risk groups for the development of an unfavorable outcome of tuberculosis treatment in comorbid patients.
Objective. Identification of modifiable medical factors that increase the risk of unfavourable treatment outcomes in patients with tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) in order to develop measures to improve the effectiveness of treatment.
Methods. A simple cross-sectional study included 204 patients with a newly diagnosed TB and COPD; there were 180 men (88.2%) and 24 women (11.8%; χ2=41.15, p=0.000), mean age (Me 25; 75) – 48.25 (38; 57) years. All patients underwent 24-hour blood pressure monitoring, echocardiography (EchoCG), spirography (SPG). The effect of the state of central hemodynamics (in terms of 24-hour blood pressure monitoring), structural and functional changes in the myocardium (in terms of echocardiography), pulmonary function (in terms of SPG), and characteristics of the tuberculous process on the outcome of TB in comorbid (TB+COPD) patients were assessed. The factor analysis with varimax rotation was used; to determine the number of factors, the Guttman method with scree test was used. 47 medical parameters that determine the likelihood of an unfavorable outcome of TB treatment in COPD patients were analyzed. The variance explained by 17 consecutive significant factors was 81.3% of the contribution of all factors, which indicates the sufficient adequacy of the developed model.
Results. The greatest influence on the prognosis of TB treatment was exerted by a group of factors combining the parameters characterizing the state of central hemodynamics according to the results of 24-hour blood pressure monitoring, with a contribution to the total variance of 29.03%, which were defined as modifiable medical factors. Further, there was a group of factors characterizing the features of the course of the TB process with a contribution of 24.76%, combining the localization, prevalence, form of TB and the chemotherapy regimen. Th#e group of factors responsible for the heart pump function were on the third place in terms of the degree of influence on the prognosis of treatment, with a contribution of 19.5%, which was assessed by the results of echocardiography and was regarded as partially modifiable. The least influence was exerted by the factors characterizing the pulmonary function of external respiration, with a contribution of 8.01%. This group combined SPG indicators/(FEV1, FVC and FEV1/FVC) and was considered as partially modifiable using medications and non-drug measures.
Conclusion. The risk group for the development of an unfavorable outcome of TB treatment includes persons with significant changes in the bronchopulmonary and cardiovascular systems, which can be detected during 24-hour blood pressure monitoring, echocardiography and SPG. In this connection, it is possible that the prognosis of treatment of some patients will depend not so much on the activity of the tuberculous process, but on comorbid conditions. To prevent an unfavorable outcome of TB treatment in comorbid patients, it is necessary to correct bronchopulmonary and cardiovascular pathology with the involvement of various specialists (therapists, pulmonologists, cardiologists) to ensure an individualized approach, prescribe timely and adequate therapy and increase the effectiveness of therapy for the underlying disease.
About the Autors
Corresponding author: Natalya V. Bagisheva, Cand. Sci. (Med.), Associate Professor at the Department of Outpatient Therapy and Internal Diseases, Omsk State Medical University, Omsk, Russia; email@example.com
Address: 12 Lenin St., Omsk 644099, Russian Federation