A novel risk factor for predicting anti-tuberculosis drug resistance in patients with tuberculosis complicated with type 2 diabetes mellitus. (August 2020)

• Record Type: Journal Article
• Authors: Lyu, Mengyuan; Wang, Dongmei; Zhao, Junwei; Yang, Zengwei; Chong, Weelic; Zhao, Zhenzhen; Ming, Liang; Ying, Binwu
• Is Part Of: International journal of infectious diseases. Volume 97(2020)
• Page Start: 69
• Page End: 77
• Publication Date: 2020-08
• Subjects: Diabetes mellitus -- Drug resistance -- HbA1c -- Predictive model -- Tuberculosis; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.05.080
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Glycosylated hemoglobin (HbA1c) grading (7%) was an independent risk factor for multidrug-resistance (MDR) in tuberculosis complicated with type 2 diabetes mellitus (TB-T2DM) patients. HbA1c grading (7%) improved the capacity of the predictive model for MDR. The predictive model could effectively assess the risk of MDR for TB-T2DM patients. Abstract: Objectives: This study aimed to explore the relationship between glycosylated hemoglobin (HbA1c) and the risk of anti-tuberculosis (TB) drug resistance for TB-type 2 diabetes mellitus (T2DM) patients. Methods: From March 2014 to June 2019, medical records from multiple centers were searched. Logistic regression analyses were performed. A predictive model for multidrug-resistance (MDR) was developed and validated. Calibration and discrimination of the model were assessed. Results: Inconsistent results were found in the systemic review. A multicenter chart review with 657 records was thus conducted. The HbA1c <7% group and HbA1c ≥7% group had 390 and 267 patients, respectively. The HbA1c < 7% group had a lower risk of developing rifampicin resistance, isoniazid resistance and MDR, with odd ratios (ORs) of 1.904 ( p = 0.001), 2.896 ( p < 0.001) and 3.228 ( p < 0.001), respectively. The between-group differences in the risk of anti-TB drug resistance were analyzed based on data from three provinces in China. After adding HbA1c grading, the predictive model for MDR (https://mengyuan.shinyapps.io/Shinyapp/ ) showed excellent capacity with an AUC of 75.4% in the training set (Sichuan and Gansu) and 73.9% in the internal validation set (Henan). The performances in calibration, prediction probabilities and net clinical benefit were significantly improved by HbA1c grading. Conclusions: HbA1c grading was an independent risk factor for isoniazid resistance and MDR in TB-T2DM patients.