Iceu Dimas Kulsum,1 Erlina Burhan,1 Rochismandoko2
1Departemen Pulmonologi dan Kedokteran Respirasi Fakultas Kedokteran Universitas Indonesia, RSUP Persahabatan, Jakarta
2Departemen Ilmu Penyakit Dalam, RSUP Persahabatan, Jakarta
Background: The prevalence of diabetes mellitus (DM) continues to increase in developing countries where TB is endemic. Immunocompromised due to DM increases the risk of TB infection and delayed sputum smear conversion. This study would like to evaluate the proportion of sputum smear conversion failure and analyze factors that influence it.
Methods: This retrospective cohort study was conducted at Perahabatan hospital from March until September 2015, all new cases TB with DM patients were included. Sputum smear conversion evaluated at the end of second month of TB treatment and influencing factors analyzed by bivariate and multivariate.
Results: The proportion of sputum conversion failures in TB-DM patients was 43.04% vs. 22.75% in without DM (p <0.001, CI95% 0.11 to 0.30). Relative risk of conversion failure was 1.89 times higher in DM patients. The risk factors for conversion failure are positivity rate of sputum AFB before treatment (p = 0.021), HbA1c (p = 0.014), Pre Prandial Blood Glucose(p = 0.047), Post Prandial Blood Glucose (p = 0.030), serum albumin (p = 0.013) and cavity on chest x-ray (p = 0.033). Risk factors of sputum smear conversion failure by multivariate analysis are low serum albumin levels (p = 0.046, 0.464 aOR, CI95% from 0.218 to 0.986), high positivity rate of sputum smear before treatment (p = 0.009, 2.313 aOR, CI95% 1.230 to 4.349) and higher HbA1c levels (p = 0.018, 1.298 aOR,CI 95% from 1.047 to 1.610).
Conclusion: Diabetes mellitus increases the risk of sputum smear conversion failure, was influenced by higher positivity rate of sputum smear before treatment, uncontrolled diabetes, cavity lession and low serum albumin levels. (J Respir Indo. 2017; 37: 109-18)
Keywords: Sputum smear conversion, AFB, TB, DM