Choi Hongjo, Mok Jeongha, Kang Young Ae, Jeong Dawoon, Kang Hee-Yeon, Kim Hee Jin, Kim Hee-Sun, Jeon Doosoo
Division of Health Policy and Management, Korea University College of Health Science, Seoul, Korea.
Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Yonsei Med J. 2025 Jan;66(1):16-24. doi: 10.3349/ymj.2024.0048.
This study aimed to evaluate the prognosis of the not evaluated (NE) group by comparing it with the lost to follow-up (LTFU) group among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB).
This was a retrospective longitudinal follow-up study using an integrated database constructed by data linkage of the three national databases. This database included 7226 cases of MDR/RR-TB notified between 2011 and 2017 in South Korea.
Among the 7226 MDR/RR-TB cases, 730 (10.1%) were classified as LTFU group, and 353 (4.9%) as NE group. When comparing NE group with LTFU group, there were no significant differences in the all-cause mortality rate (18.1% vs. 13.8%, =0.065), median time to death [404 days (interquartile range, IQR 46-850) vs. 443 days (IQR 185-1157), =0.140], and retreatment rate (26.9% vs. 22.2%, =0.090). After adjusting for potential confounders, the adjusted hazard ratio (aHR) for all-cause mortality (aHR 1.11; 95% confidence interval 0.80-1.53; =0.531) in NE group was not significantly different than that in LTFU group. Among retreated cases, NE group had a higher treatment success rate (57.9% vs 43.8%, =0.029) and a lower LTFU rate (11.6% vs 38.3%, <0.001) compared to LTFU group.
NE group had an unfavorable outcome comparable to LTFU group, suggesting undetected cases of LTFU or deaths during the referral process. Establishing an efficient patient referral system would contribute to reducing the incidence of NE cases.
本研究旨在通过比较耐多药/利福平耐药结核病（MDR/RR-TB）患者中未评估（NE）组和失访（LTFU）组的情况，评估NE组的预后。
这是一项回顾性纵向随访研究，使用通过链接三个国家数据库构建的综合数据库。该数据库包含2011年至2017年在韩国报告的7226例MDR/RR-TB病例。
在7226例MDR/RR-TB病例中，730例（10.1%）被归类为LTFU组，353例（4.9%）为NE组。比较NE组和LTFU组时，全因死亡率（18.1%对13.8%，P=0.065）、中位死亡时间[404天（四分位间距，IQR 46-850）对443天（IQR 185-1157），P=0.140]和再治疗率（26.9%对22.2%，P=0.090）无显著差异。在调整潜在混杂因素后，NE组全因死亡率的调整风险比（aHR）（aHR 1.11；95%置信区间0.80-1.53；P=0.531）与LTFU组无显著差异。在再治疗病例中，与LTFU组相比，NE组的治疗成功率更高（57.9%对43.8%，P=0.029），失访率更低（11.6%对38.3%，P<0.001）。
NE组的不良结局与LTFU组相当，提示存在失访未被发现的病例或转诊过程中的死亡病例。建立高效的患者转诊系统将有助于降低NE病例的发生率。
