Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study.
Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study.
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芬兰结核病治疗结果不良的危险因素：一项队列研究。
DOI：
10.1186/1471-2458-7-291
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发表时间：
2007-10-14
影响因子：
4.5
通讯作者：
Ruutu, Petri
中科院分区：
文献类型：
--
作者：
Vasankari, Tuula;Holmstrom, Pekka;Ollgren, Jukka;Liippo, Kari;Kokki, Maarit;Ruutu, Petri
我们在一个为期两年的队列研究中调查了影响所有经治疗的培养证实的肺结核（TB）病例治疗结局的患者和治疗系统依赖性因素，以建立改善结局的基础。提取1995 - 1996年所有病例的病历以评估治疗结果。结果分为三组：有利，死亡和其他不利。在单变量和多变量分析中评估不利结局的预测因素。在629例病例中，441例（70.1%）取得了良好的结局，17.2%（108例）死亡，12.7%（80例）发生了其他不利的结局。死亡的重要独立风险因素是男性、高龄、非HIV相关免疫抑制和导致停止治疗的任何非肺部专科。既往结核病史与死亡风险呈负相关。对于其他不利的治疗结局，显著的风险因素是治疗暂停、INH+RIF+EMB/SM治疗以及治疗结束时内科专科负责。我们观察到，负责治疗的专科与肺部以外的不利结局有显著相关性，但与病例数量无关，这对系统安排有影响。与免疫抑制和高龄相关的不良结局，以及频繁的合并症，强调了低怀疑阈值，快速诊断的可用性和早期经验性治疗作为试图改善结核病发病率非常低的国家的治疗结果的可能方法。
We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes. Medical records of all cases in 1995 – 1996 were abstracted to assess outcome of treatment. Outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis. Among 629 cases a favourable outcome was achieved in 441 (70.1%), 17.2% (108) died and other unfavourable outcome took place in 12.7% (80). Significant independent risk factors for death were male sex, high age, non-HIV -related immunosuppression and any other than a pulmonary specialty being responsible for stopping treatment. History of previous tuberculosis was inversely associated with the risk of death. For other unfavourable treatment outcomes, significant risk factors were pause(s) in treatment, treatment with INH+RIF+EMB/SM, and internal medicine specialty being responsible at the end of the treatment. We observed a significant association with unfavourable outcome for the specialty responsible for treatment being other than pulmonary, but not for the volume of cases, which has implications for system arrangements. Poor outcomes associated with immunosuppression and advanced age, with frequent comorbidity, stress a low threshold of suspicion, availability of rapid diagnostics, and early empiric treatment as probable approaches in attempting to improve treatment outcomes in countries with very low incidence of TB.