Validating the surgical indication value of the LTB-S classification system for drug resistant tuberculosis

• Published in: International journal of infectious diseases Vol. 95; pp. 67 - 73
• Main Authors: Lin, Wang, Yifei, Wang, Zilu, Wen, Fan, Xia, Hui, Chen, Yijun, Zhu, Heping, Xiao, Shuihua, Lu, Xiyong, Dai, Haijiang, Wang, Chaolin, Huang, Wei, Chang, Ka-Wing, Wong, Yanzheng, Song
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.06.2020; Elsevier
• Subjects: Complication; Extensively drug resistant tuberculosis; LTB-S; Multi-drug resistant tuberculosis; Surgery; Treatment outcome; Treatment outcome; XDR- TB; Extensively drug resistant tuberculosis; LTB-S; Surgery; Complication; MDR-TB; Multi-drug resistant tuberculosis; WHO
• DOI: 10.1016/j.ijid.2020.02.030
• ISSN: 1201-9712

•We propose a patient classification system for resection of pulmonary tuberculosis based on lesion(s), treatment history, body and surgery (LTB-S), a scoring system based on objective clinical parameters for judging the prognosis of adjunctive surgery.•We found that LTB-S showed predictive value for the prognosis of the adjunctive surgery and could guide management of drug-resistant tuberculosis.•Multivariance analysis indicated that localized lesions were the most predictive clinical parameter for a successful therapeutic surgery and for minimal complication risks when combined with treatment history. Currently there is no guideline based on preoperative clinical parameters for assessing the prognosis of the adjunctive surgery for drug-resistant tuberculosis. We retrospectively analyzed 138 patients who had undergone surgical resection as a treatment for drug- resistant tuberculosis after 24 months. Four clinical parameters on lesion type, treatment history, body physiological status, and surgery approach were evaluated. Categorical preoperative clinical parameters were analyzed by ordinal logistic regression model when considering postoperative complications as outcomes ordered in terms of severity. Statistically significant parameters were then combined in a single classification system for predicting the outcomes of the adjunctive surgery. Diffused, progressive bilateral lesions, or active/progressive extra pulmonary tuberculosis (L3), and history of less than 2 months treatment before surgery (T3) were the strongest predicative parameters for postoperative complications and for surgery failure. Classification systems based on the four parameters were found to have a statistically significant effect on postoperative complications and postoperative efficacy. 24- month follow up indicated a high cure rate (above 95.5%) among patients without T3, L3, or severe physiological complications (B3). A classification system based on objective clinical parameters showed predicative value for the prognosis of the adjunctive surgery and could guide management of drug-resistant Tuberculosis.