[A cohort study on the outcome of multidrug-resistant tuberculosis in elderly patients]

To investigate the clinical curative effect and outcomes of multidrug-resistant tuberculosis (MDR-TB) in elderly patients.

Fifty-nine elderly patients with MDR-TB were enrolled from Shanghai Pulmonary Hospital from January 2007 to January 2010, and 80 younger patients with MDR-TB during the same period served as the control group. Clinical characteristics, outcomes and adverse effects of treatment were reviewed, and the data of the 2 groups were compared using cohort analysis. Comparisons of categorical variables were performed using the Pearson Chi-square tests, and differences between groups were compared by Fisher's exact test.

Compared with those of the younger patients, the clinical symptoms of the elderly patients showed no significant differences except shortness of breath. The proportion of retreated patients in the elderly patients (96.6%, 57/59) was significantly higher than that in the younger group (86.3%, 69/80) (χ² = 4.299, P < 0.05). The proportion of the patients with lesions involving 5-6 lung fields in the elderly group was 57.6% (34/59), higher than that in the younger group (22.5%, 18/80) (χ² = 17.894, P < 0.01). The treatment success rate in the elderly MDR-TB group was 28.2% (17/59), lower than that in the younger group (51.3%, 41/80) (χ² = 7.029, P < 0.01). The death rate in the elderly group was 17.0% (10/59), significantly higher than that in the younger group (3.4%, 3/80) (χ² = 6.837-17.894, P < 0.05). The incidence of liver injury in the elderly group was higher than that in the younger group (23.7%, 14/59 vs 10.0%, 8/80,χ² = 4.804, P < 0.05), and so was that of kidney dysfunction (10.2%, 6/59 vs 1.3%, 1/80, χ² = 5.649, P < 0.05).

In elderly patients with MDR-TB, the pulmonary lesions were extensive, the number of retreated cases was higher, and the incidence of adverse drug reactions was also higher. The treatment success rate was lower while the mortality rate was higher for elderly patients with MDR-TB.