Risk factors and survival analysis of time to death among multidrug-resistant tuberculosis patients: a case study at Nigist Ellen Mohammed Memorial Comprehensive Specialized Hospital

Objective: Multidrug-resistant tuberculosis (MDR-TB), caused by bacteria that are resistant to the most effective anti-tuberculosis drugs, is a rising global issue with varying mortality rates among patients. This study aimed to identify the factors contributing to mortality in MDR-TB patients at the Nigist Ellen Mohammed Memorial Comprehensive Specialized Hospital (NEMMCSH) in Hosanna, Ethiopia. Patients and Methods: A retrospective study was conducted using a cohort of patients diagnosed with MDR-TB at the NEMMCSH from January 2016 to December 2022. Data analysis included the Kaplan-Meier method to estimate survival rates, the log-rank test to assess differences in survival among the patients and a Cox regression model to identify factors influencing survival. Results: Of 268 MDR-TB patients, 111 (41.4%) died, and 157 (58.6%) were censored. The average mortality rate of the patients with MDR-TB in the hospital was 12 months. Female patients had a significantly shorter time to death than males, as we have seen the value of hazard ratio (HR) (HR = 0.937; p = 0.003), alcohol users (HR = 0.866), and those with decreased weight (HR = 0.998; p = 0.001). Conversely, patients with extra-pulmonary MDR-TB (HR = 1.209; p = 0.000), urban residents (HR = 1.039; p = 0.001), and those with negative HIV status (HR = 1.664; p = 0.001) had a longer time to death. Conclusions: Among the various factors examined in this study, significantly higher mortality rates and shorter survival times were observed in males, rural residents, smokers, HIV patients, and extra-pulmonary MDR-TB patients. Significant predictors of mortality included sex, residence, HIV status, smoking status, clinical completion, comorbidities, drug history, weight, MDR-TB type, and alcohol use. Therefore, modified healthcare strategies for high-risk variables to improve survival outcomes and reduce MDR-TB-related mortality are needed. Moreover, comprehensive medical care and dedicated counseling services are essential.