Comparison of the treatment outcomes and identification of the risk factors associated with unfavorable outcomes among extra pulmonary and pulmonary tuberculosis patients under NTEP

India contributes approximately 27% to the global Tuberculosis burden, with Pulmonary TB representing the predominant form of the disease. Extrapulmonary Tuberculosis contributes to around 20% of total TB burden worldwide. Diagnosing epTB is more challenging compared to pTB. Despite adequate awareness and efforts, it still remains under-diagnosed and underreported even in high burden countries like India. Identification of the risk factors associated with unfavorable outcomes can definitely improve morbidity and mortality burden of the disease.

Medical records of 2624 patients above 18 years of age and treated for TB under NTEP over 1 year (1 June 2023 to 31 May 2024) at district Mohali were reviewed retrospectively. Treatment outcomes were classified as favorable (cured/treatment completed) and unfavorable (death, failure, lost to follow-up, regimen change). Multivariable binary logistic regression was performed to identify factors associated with unfavorable outcomes and death.

Out of 2624, 1729 (65.9%) had pTB and 895 (34.1%)epTB. Favorable treatment outcome was observed in 1603 (61%) pTB and 878 (33.5%) epTB. Deaths were more in pTB(69,3.9%) as compared to epTB(14,1.6%). On regression analysis for death as an outcome, factors like recurrent TB (AOR 3.695; CI [1.356–10.070]; p-0.011), age 41–60 years (AOR 4.138; CI [2.217–7.723]; p-<0.001), Age > 60 years (AOR 2.409; CI [1.246–4.658]; p-0.009), were independently associated with higher odds of unfavorable treatment outcome.

Recurrent TB in young adults is associated with unfavorable treatment outcomes whereas BMI above 25 is associated with unfavorable outcome in epTB patients. Enhanced clinical awareness about the disease presentation for early diagnosis, availability of diagnostic tests for microbiological confirmation and detection of resistance are important for early diagnosis and optimal management of TB.