OBJECTIVES: According to WHO, tuberculosis (TB) is one of leading cause of mortality. The mortality rate in Malaysia is accelerating due to high transmission of TB. To control TB, determination of associated factors of unsuccessful treatment outcomes is necessary. This study was aimed to investigate the factors associated with unsuccessful treatment outcomes in smear TB patients.

METHODS: A retrospective study was conducted in Hospital Pulau Pinang in Malaysia. Records of 351 confirmed smear-positive TB patients were reviewed from 2014-2020. Data analysis was performed in SPSS 21 using Cox regression for univariate and multi variate analysis.

RESULTS: A 78.7% of the study population were male with mean age of (49.5 + 16.4). 46(20.8%) patients died, 21(9.5%) had Multidrug Resistant Tuberculosis (MDR-TB), 1(0.5%) patient failed the treatment and 2(0.9%) patients default the treatment. Univariate Cox regression analysis showed certain variables which include smoking, drinking, high levels of white blood cells and urea, receiving separated therapy during the intensive phase of treatment, history of TB and multidrug resistant have significant relation with unsuccessful outcomes. The final results of multivariate Cox regression analysis indicated levels of white blood cells (p-value= .031, HR= 1.058, 95% CI= 1.005 - 1.113) and urea (p-value= .021, HR= 1.028, 95% CI= 1.004 - 1.052) were positively associated while hemoglobin levels (p-value= .002, HR= .800, 95% CI= .697 - .919) and no history of TB (p-value= .036, HR= .511, 95% CI= .272 - .959) were negatively correlated with unsuccessful outcomes. Treatment success rate was 68.3%.

CONCLUSIONS: In this study, high levels of white blood cells and urea were major risk factors of unsuccessful treatment outcomes. Smear positive TB patients with high levels of white blood cells and urea should be monitored intensively. Our study has shared insightful results on the risk factors associated with unsuccessful treatment outcomes.