HIV co-infection triples MDR-TB mortality risk; low BMI and anaemia also raise riskHIV and other risk factors linked to multidrug-resistant tuberculosis deaths

This systematic review, meta-analysis, and meta-regression evaluated predictors of mortality and recurrence in patients with multidrug-resistant tuberculosis (MDR-TB). The analysis pooled data from 36,693 patients across multiple studies, though the specific number of included studies and the study settings were not reported. The primary outcome was mortality, with recurrence as a secondary outcome. The meta-analysis identified five key factors associated with increased mortality: HIV co-infection, lower educational attainment (12 years or less), low body mass index (BMI), anaemia, and alcohol use. Each factor was associated with a statistically significant increase in the odds of death. Specifically, HIV co-infection was associated with an odds ratio (OR) of 2.80 (95% CI: 1.92-4.09; p <.001). Lower educational attainment (≤12 years) was associated with an OR of 2.67 (95% CI: 1.64-4.38; p =.003). Low BMI was associated with an OR of 3.15 (95% CI: 2.28-4.36; p =.001). Anaemia was associated with an OR of 3.53 (95% CI: 1.03-12.09; p =.04). Alcohol use was associated with an OR of 2.94 (95% CI: 1.08-8.00; p =.04). These effect sizes indicate that each of these factors approximately doubles or triples the odds of death in MDR-TB patients. For recurrence, the meta-analysis found that comorbidities and low educational levels were associated with a higher risk, but specific effect sizes and confidence intervals were not reported. The safety and tolerability of any interventions were not reported, as this was an observational meta-analysis of risk factors, not a clinical trial. The main limitation noted was that only five studies assessed recurrence, limiting the robustness of that finding. Additionally, the analysis is based on observational data, so the associations do not establish direct causation. The results should be interpreted with caution, as residual confounding and heterogeneity across studies may influence the findings. In comparison to prior evidence, this meta-analysis extends the understanding of MDR-TB outcomes by quantifying the impact of several modifiable and non-modifiable risk factors. Prior coverage has focused on treatment regimens (e.g., BPaLM, linezolid-containing regimens) and regional prevalence, but this analysis provides a broader risk-stratification framework. The clinical implications are significant: these findings can help clinicians identify MDR-TB patients at higher risk of mortality and recurrence, allowing for more intensive monitoring and targeted interventions. For example, patients with HIV co-infection, low BMI, anaemia, or alcohol use may benefit from enhanced nutritional support, management of comorbidities, and closer follow-up. However, because the analysis does not establish causation, interventions based on these associations should be implemented with the understanding that they may not directly reduce mortality. Future research should focus on prospective studies to confirm these associations and to evaluate whether addressing these risk factors improves outcomes. Additionally, more studies are needed to better understand predictors of recurrence, given the limited number of studies available. Overall, this meta-analysis provides valuable evidence for risk stratification in MDR-TB, but the findings should be applied with appropriate caution.