Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis

Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camara; Mafouné Diallo; Souleymane Camara; Boubacar Bah; Magassouba Aboubacar Sidiki; Alpha Oumar Barry; Thierno Hassane Diallo; Oumou Younoussa Sow

doi:doi:10.11648/j.cajph.20200601.16

Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camara, Mafouné Diallo, Souleymane Camara, Boubacar Bah, Magassouba Aboubacar Sidiki, Alpha Oumar Barry, Thierno Hassane Diallo, Oumou Younoussa Sow

Published in Central African Journal of Public Health (Volume 6, Issue 1)

Received: 18 December 2019 Accepted: 2 January 2020 Published: 16 January 2020

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Abstract

Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Among 232 patients with MDR-TB enrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%. Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m² (p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (c-index = 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-L_X² = 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.

Published in	Central African Journal of Public Health (Volume 6, Issue 1)
DOI	10.11648/j.cajph.20200601.16
Page(s)	33-41
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Nomogram, Multidrug-resistant, Tuberculosis, Guinea

References

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Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camara, Mafouné Diallo, Souleymane Camara, et al. (2020). Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis. Central African Journal of Public Health, 6(1), 33-41. https://doi.org/10.11648/j.cajph.20200601.16

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ACS Style

Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camara; Mafouné Diallo; Souleymane Camara, et al. Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis. Cent. Afr. J. Public Health 2020, 6(1), 33-41. doi: 10.11648/j.cajph.20200601.16

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Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camara, Mafouné Diallo, Souleymane Camara, et al. Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis. Cent Afr J Public Health. 2020;6(1):33-41. doi: 10.11648/j.cajph.20200601.16

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@article{10.11648/j.cajph.20200601.16,
  author = {Boubacar Djelo Diallo and Alhassane Diallo and Lansana Mady Camara and Mafouné Diallo and Souleymane Camara and Boubacar Bah and Magassouba Aboubacar Sidiki and Alpha Oumar Barry and Thierno Hassane Diallo and Oumou Younoussa Sow},
  title = {Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis},
  journal = {Central African Journal of Public Health},
  volume = {6},
  number = {1},
  pages = {33-41},
  doi = {10.11648/j.cajph.20200601.16},
  url = {https://doi.org/10.11648/j.cajph.20200601.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20200601.16},
  abstract = {Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Among 232 patients with MDR-TB enrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%. Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2 (p = 0.0253; aOR = 2.94), good adherence to treatment (p = c-index = 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2 = 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.},
 year = {2020}
}

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TY - JOUR
T1 - Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis
AU - Boubacar Djelo Diallo
AU - Alhassane Diallo
AU - Lansana Mady Camara
AU - Mafouné Diallo
AU - Souleymane Camara
AU - Boubacar Bah
AU - Magassouba Aboubacar Sidiki
AU - Alpha Oumar Barry
AU - Thierno Hassane Diallo
AU - Oumou Younoussa Sow
Y1 - 2020/01/16
PY - 2020
N1 - https://doi.org/10.11648/j.cajph.20200601.16
DO - 10.11648/j.cajph.20200601.16
T2 - Central African Journal of Public Health
JF - Central African Journal of Public Health
JO - Central African Journal of Public Health
SP - 33
EP - 41
PB - Science Publishing Group
SN - 2575-5781
UR - https://doi.org/10.11648/j.cajph.20200601.16
AB - Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Among 232 patients with MDR-TB enrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%. Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2 (p = 0.0253; aOR = 2.94), good adherence to treatment (p = c-index = 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2 = 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.
VL - 6
IS - 1
ER -

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Author Information

Boubacar Djelo Diallo

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Alhassane Diallo

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Lansana Mady Camara

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Mafouné Diallo

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Souleymane Camara

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Boubacar Bah

Carrière Tuberculosis Center, Conakry, Guinea
Magassouba Aboubacar Sidiki

National Tuberculosis Control Program, Conakry, Guinea
Alpha Oumar Barry

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Thierno Hassane Diallo

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea
Oumou Younoussa Sow

Department of Pneumo-phtisiology, Ignace Deen National Hospital, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, CHU Conakry, Guinea

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Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camara, Mafouné Diallo, Souleymane Camara, et al. (2020). Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis. Central African Journal of Public Health, 6(1), 33-41. https://doi.org/10.11648/j.cajph.20200601.16

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Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camara; Mafouné Diallo; Souleymane Camara, et al. Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis. Cent. Afr. J. Public Health 2020, 6(1), 33-41. doi: 10.11648/j.cajph.20200601.16

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AMA Style

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camara, Mafouné Diallo, Souleymane Camara, et al. Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis. Cent Afr J Public Health. 2020;6(1):33-41. doi: 10.11648/j.cajph.20200601.16

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@article{10.11648/j.cajph.20200601.16,
  author = {Boubacar Djelo Diallo and Alhassane Diallo and Lansana Mady Camara and Mafouné Diallo and Souleymane Camara and Boubacar Bah and Magassouba Aboubacar Sidiki and Alpha Oumar Barry and Thierno Hassane Diallo and Oumou Younoussa Sow},
  title = {Development of a Prognosis Nomogram of Treatment Outcomes for MDR-tuberculosis in Guinea (Conakry): A Retrospective Cohort Analysis},
  journal = {Central African Journal of Public Health},
  volume = {6},
  number = {1},
  pages = {33-41},
  doi = {10.11648/j.cajph.20200601.16},
  url = {https://doi.org/10.11648/j.cajph.20200601.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20200601.16},
  abstract = {Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Among 232 patients with MDR-TB enrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%. Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2 (p = 0.0253; aOR = 2.94), good adherence to treatment (p = c-index = 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2 = 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.},
 year = {2020}
}

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