Multidrug resistant tuberculosis (MDR-TB) in Eritrea: a retrospective cohort analysis of mortality and associated factors (2013 - 2023).

Authors

Hagos Andom Teumezgi, Nesredin Nuru Suud, Yohannes Mehari Berhane, Saleh Mohammed Said, Daniel Tesfagherghish Hailu, Kidane Kifle Habtetsion, Tekie Merawi Weldetnsae, Oliver Okoth Achila

Published in

Frontiers in cellular and infection microbiology. Volume 16. Pages 1793864. Epub Jul 20, 2026.

Abstract

Multi-drug resistant tuberculosis (MDR-TB) continues to be a pressing global health concern, indiscriminate of country border and defined by higher mortality and higher treatment costs. Here, we sought to describe the MDR/RR-TB patients' clinical profile and outcomes in Eritrea. In particular, focus was directed at hemato-biochemical predictors of mortality.
This study was a retrospective (2013-2023) analysis of patients records at the Merhano MDR/RR-TB hospital in Asmara, Eritrea. In total, records from 257 patients were reviewed. Data on treatment outcomes, hematological, biochemical and demographic characteristics was subsequently abstracted using a structured check-list. We incorporated Kaplan-Meier curve and multivariate Cox regression model to evaluate the relationship between covariates and mortality.
The mean age (± Standard deviation (SD)) at enrolment was: 41.7 years (± 16.5), and the number of males in the cohort was 157(61.1%). Of all patients, 91(37.80%) had anemia (severe anemia, 18(7.5%); 205(79.8%) experienced adverse drug reaction (ADR); 30 (12.1%) had HIV; 45 (20.4%) had eGFR _Creat < 60 mL/min; 27(11.6%) had elevated BUN; 33(14.5%) had APRI score > 0.5; 45(21.6%) had hypothyroidism; 14 (5.9%) had thrombocytopenia; and 126(53.4%) had thrombocytosis. During treatment, 162 (63.0%, 95% CI: 57 - 69.6%) patients were cured, 45(17.5%, 95% CI: 13.5 - 22.0%) completed treatment, 40 (15.6%, 95% CI: 10.5-19.4%) died, and 8(3.1%, 95% CI: 1.2 - 5.1%) were Lost to follow up. Median (IQR) time to death was 33 days (10-130 days). After 137-321 person days follow up (PDFU), the incidence of death (95% CI) was 2.91(2.11 - 4.11) per 10-000 PDFU. Predictors of mortality included age >60 years; Weight <30 Kg at baseline; Thrombocytopenia; Severe anemia; APRI score > 0.5; Hypothyroidism; elevated BUN, high serum creatinine (SCr) levels; and eGFR _Creat < 60 mL/min. In the multivariate Cox regression model, a unit increase in hemoglobin concentration and weight reduced the risk of death by 0.79(95% CI: 0.67 - 0.93), P = 0.005 and 0.96(95% CI: 0.91-1.01), respectively. Further, higher likelihood of death was associated with elevated SCr (>12 mg/dL) levels (aHR = 6.33 (95% CI: 2.33 - 17.19), P<0.001, and APRI Score >0.5 (aHR = 2.78(95% CI: 1.65 - 4.70), P<0.001. In contrast, a unit increase in age increased the risk of death (aHR = 1.045(95 CI%: 1.02 - 1.07), P<0.001.
The magnitude of death and other unfavorable treatment outcome for MDR/RR-TB was low. Of greater concern, however, was the critical condition of patients at presentation. Proactive strategies are needed to improve early detection of MDR/RR-TB and supportive care in patients with severe complications. In addition, additional research on MDR/TB-mortality is needed, especially among vulnerable subpopulations.

PMID:
42548840
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

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