Factors associated with mortality and recurrence among patients with multidrug-resistant tuberculosis (MDR-TB): a systematic review, meta-analysis and meta-regression.

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) remains a major global health concern due to its high mortality and recurrence rates. Understanding the factors associated with these adverse outcomes is essential for guiding targeted interventions and strengthening TB control strategies.

OBJECTIVE

To synthesise evidence on factors associated with mortality and recurrence among patients with MDR-TB.

METHODS

A systematic review and meta-analyses were conducted following PRISMA guidelines. Searches were performed in PubMed, CINAHL, Scopus, Embase and Web of Science from inception to 23 February 2025 without year restrictions. A random-effects model was used to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Newcastle-Ottawa Scale. Subgroup and meta-regression analyses were conducted.

RESULTS

Thirty-five studies encompassing 36,693 patients with MDR-TB were included. Pooled analyses identified several significant predictors of mortality, including HIV co-infection (OR = 2.80; 95% CI: 1.92-4.09; p < .001), lower educational attainment (≤12 years) (OR = 2.67; 95% CI: 1.64-4.38; p = .003), low body mass index (OR = 3.15; 95% CI: 2.28-4.36; p = .001), anaemia (OR = 3.53; 95% CI: 1.03-12.09; p = .04) and alcohol use (OR = 2.94; 95% CI: 1.08-8.00; p = .04). Only five studies assessed recurrence, indicating higher risk among individuals with comorbidities, and those with low educational levels.

CONCLUSION

Mortality and recurrence remain major challenges in MDR-TB management. Key predictors, HIV co-infection and low education for mortality, and comorbidities and low educational level for recurrence, highlight the need to strengthen health systems, expand TB-HIV co-management and implement targeted education to reduce adverse outcomes and advance global TB elimination.

REGISTRATION: CRD420251032658.