Coexistence of dementia with smear-positive pulmonary tuberculosis is associated with patient in-hospital mortality
Coexistence of dementia with smear-positive pulmonary tuberculosis is associated with patient in-hospital mortality
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DOI：
10.1016/j.resinv.2019.01.004
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发表时间：
2019-07-01
影响因子：
3.1
通讯作者：
Miyashita, Yoshihiro
中科院分区：
文献类型：
--
作者：
Saiki, Masafumi;Iijima, Yuki;Miyashita, Yoshihiro
背景：痴呆对肺结核（TB）患者生存率的影响尚不清楚。本研究旨在描述影响住院死亡率的危险因素与肺结核和共病dementia.Methods：9年，病历为基础的回顾性研究，住院的成人患者新诊断的，涂片阳性，非多药耐药肺结核没有人类免疫缺陷病毒感染进行。收集临床表现、生化检查、影像学检查结果和临床结局。比较两组之间的变量。将统计学显著（p值< 0.05）变量输入多变量逐步逻辑回归模型。采用Kaplan-Meier法进行生存分析，并通过log-rank test.Results进行组间比较：在279例入选患者（178例男性，中位年龄76岁）中，死亡率为12.2%（34/279）。单变量分析显示，在医院死亡的患者中痴呆症的发生率高于幸存患者。多变量逐步logistic分析显示，痴呆与较高的住院死亡率显著相关（比值比，3.20; 95%可信区间，1.15-8.88，p = 0.026）。此外，亚组生存曲线显示，痴呆症与降低的生存率，即使调整年龄后（对数秩检验，p = 0.0007）。结论：痴呆症合并肺结核与患者住院死亡率相关。医务工作者应了解涂阳肺结核患者的痴呆症，以确定高死亡率群体。(C)2019日本呼吸学会Elsevier B. V.出版，保留所有权利。
Background: The impact of dementia on the survival of patients with pulmonary tuberculosis (TB) remains unclear. This study sought to describe the risk factors influencing inhospital mortality in patients with pulmonary TB and comorbid dementia.Methods: A 9-y, medical record-based retrospective study of hospitalized adult patients with newly diagnosed, smear-positive, non-multidrug-resistant pulmonary TB without human immunodeficiency virus infection was performed. Clinical presentations, biochemical tests, radiographic findings, and clinical outcomes were collected. Variables were compared between groups. Statistically significant (p-value < 0.05) variables were entered into a multivariate stepwise logistic regression model. Survival analysis was performed using the Kaplan-Meier method, and groups were compared by log-rank test.Results: Of the 279 enrolled patients (178 men; median age, 76 y), the mortality rate was 12.2% (34/279). Univariate analysis showed a higher frequency of dementia in patients who died in hospital than that in surviving patients. Multivariate stepwise logistic analysis showed that dementia was significantly associated with higher rates of in-hospital mortality (odds ratio, 3.20; 95% confidence interval, 1.15-8.88, p = 0.026). In addition, subgroup survival curves showed that dementia was associated with reduced survival rates, even after adjusting for age (log-rank test, p = 0.0007).Conclusions: The comorbidity of dementia with pulmonary TB was associated with patient in-hospital mortality. Medical practitioners should be aware of dementia in patients with smear-positive pulmonary TB to identify high-mortality groups. (C) 2019 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.