Mouafo Joseph Magloire Fossokeng, Yakam André Nana, Simo Claude, Kamdem Jules Sadefo, Bowong Samuel, Fono Louis Aimé, Noeske Jürgen
University of Douala, Cameroon.
University of Montpellier, France.
J Public Health Afr. 2023 Oct 1;14(10):2694. doi: 10.4081/jphia.2023.2694. eCollection 2023 Oct 31.
Failure to treat many pathogens is a concern. Identifying a priori, patients with potential failure treatment outcome of a disease could allow measures to reduce the failure rate. The objectives of this study were to use the Scoring method to identify factors associated with the tuberculosis unsuccessful treatment outcome and to predict the treatment outcome. A total of 1,529 patients with pulmonary tuberculosis were randomly selected in the city of Douala, Cameroon, this sample was randomly split into two parts: one subsample of 1,200 patients (78%) used as the Development sample, and the remaining of 329 patients (22%) used as the Validation sample. Baseline characteristics associated with unsuccessful treatment outcomes were investigated using logistic regression. The optimal score was based on the Youden's index. HIV positive status, active smoker and non-belief in healing were the factors significantly associated with unsuccessful treatment outcomes (P#x003C;0.05). A model used to estimate the risk of unsuccessful treatment outcome was derived. The threshold probability which maximize the area under the ROC curve was 18%. Patients for whom the risk was greater than this threshold were classified as unsuccessful treatment outcome and the others as successful. HIV positive and active smoking status were associated with death; the non-belief in healing, youth and male gender associated with lost-to-follow-up, TB antecedent and not having TB contact associated with therapeutic treatment failure. To increase the tuberculosis treatment success rate, targeted follow-up could be taken during the treatment for TB patients with previous characteristics.
未能治疗多种病原体令人担忧。事先识别出可能出现疾病治疗失败结果的患者，有助于采取措施降低失败率。本研究的目的是使用评分方法来识别与结核病治疗失败结果相关的因素，并预测治疗结果。在喀麦隆杜阿拉市随机选取了1529例肺结核患者，该样本被随机分为两部分：1200例患者的一个子样本（78%）用作开发样本，其余329例患者（22%）用作验证样本。使用逻辑回归研究与治疗失败结果相关的基线特征。最佳评分基于约登指数。HIV阳性状态、现吸烟者和不相信治愈是与治疗失败结果显著相关的因素（P<0.05）。推导了一个用于估计治疗失败结果风险的模型。使ROC曲线下面积最大化的阈值概率为18%。风险大于该阈值的患者被分类为治疗失败结果，其他患者为治疗成功。HIV阳性和现吸烟状态与死亡相关；不相信治愈、年轻和男性性别与失访相关，既往有结核病和无结核病接触史与治疗失败相关。为提高结核病治疗成功率，对于具有上述特征的结核病患者，在治疗期间可进行有针对性的随访。
