N. SmittipatR. MiyaharaT. JuthayothinP. BillamasK. DokladdaW. ImsanguanD. IntralawanK. RuksereeS. JaitrongB. ChaiyasirinrojeJ. WongjaiA. DisratthakitA. ChaiprasertS. NedsuwanS. MahasirimongkolL. Toyo-OkaK. TokunagaN. YamadaP. PalittapongarnpimH. YanaiJapan Anti-Tuberculosis AssociationUniversity of TokyoThailand Ministry of Public HealthMahidol UniversityThailand National Center for Genetic Engineering and BiotechnologyFaculty of Medicine, Siriraj Hospital, Mahidol UniversityThe Research Institute of Tuberculosis, Japan Anti-Tuberculosis AssociationMedical Life Sciences InstituteTB/HIV Research Foundation2020-01-272020-01-272019-09-01International Journal of Tuberculosis and Lung Disease. Vol.23, No.9 (2019), 972-97918157920102737192-s2.0-85073469254https://repository.li.mahidol.ac.th/handle/20.500.14594/51447© 2019 The Union. SETTING: This study was conducted among tuberculosis (TB) patients in a highly endemic Thai province. OBJECTIVE : To evaluate the association between different Mycobacterium tuberculosis lineages and clinical characteristics, especially mortality. DESIGN: We enrolled 1,304 TB patients registered from 2002-2011 with culture isolates whose lineages were identified by specific regions of deletion. Data on mortality within 1 year of follow-up were extracted from the registration system and hospital records. Mortality-associated risk factors, including bacterial lineages, as independent variables were analysed using Cox regression models. RESULT S : Of 1,304 isolates, 521 (40.0%) and 582 (44.6%) belonged to Indo-Oceanic and East-Asian lineages, respectively. Indo-Oceanic strains significantly increased the mortality risk compared with East-Asian strains (adjusted hazard ratio [aHR] 1.42, 95%CI 1.02- 1.99) or modern lineages (aHR 1.49, 95%CI 1.08-2.06) in the 172 patients who died within 1 year after TB diagnosis. The former also caused significantly higher mortality than modern lineages among patients who died within 6 months after TB diagnosis (aHR 1.62, 95%CI 1.12-2.35). No significant association was found between drug resistance and death. CONCLUS ION: In Thailand, the Indo-Oceanic lineage of M. tuberculosis increased mortality risk compared with modern lineages or the East-Asian lineage, the latter being considered highly virulent in previous studies.Mahidol UniversityMedicineArticleSCOPUS10.5588/ijtld.18.0710