Persistently high early mortality despite rapid diagnostics for drug-resistant tuberculosis cases in South Africa
Persistently high early mortality despite rapid diagnostics for drug-resistant tuberculosis cases in South Africa
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DOI：
10.5588/ijtld.17.0202
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发表时间：
2017-10-01
影响因子：
4
通讯作者：
Sinanovic, E.
中科院分区：
文献类型：
--
作者：
Schnippel, K.;Firnhaber, C.;Sinanovic, E.
目的：描述南非2012-2014年耐多药和利福平结核病登记(EDRweb)报告的耐多药/利福平结核病(MDR/RR-TB)患者死亡的时间和预测因素。设计：我们进行事件至事件生存时间分析和Cox比例风险回归。结果：在纳入分析的20653名患者中(中位年龄35岁，四分位数范围2843岁)，超过一半是男性(n=10944，53.0%)。大多数是人类免疫缺陷病毒阳性(n=14174，68.9%)，大多数人接受了抗逆转录病毒治疗(n=12471，88.0%)。在24个月时，4689名患者死亡(22.7%)；2072名患者(44.2%)报告在开始治疗MDR/RR-TB后12周内死亡。从12周到24周，死亡717人/18048人，59.5%的死亡发生在前24周内。在前12周内，基线培养结果缺失的患者(AHR 3.78，95%CI 2.94-4.86)和HIV阳性、未接受ART治疗的患者(AHR 3.40，95%CI 2.903.99)死亡的调整危险率(AHR)最高。在确诊后4周内开始MDR/RR-TB治疗的患者的死亡率高于延迟开始治疗的患者(AHR 1.57，95%CI 1.41-1.75)。结论：在EDRweb中，MDR/RR-TB治疗开始后的前几周死亡率最高。
OBJECTIVE: To describe the timing and predictors of mortality among multidrug-and rifampicin-resistant tuberculosis (MDR/RR-TB) patients reported in the South African electronic drug-resistant TB register (EDRweb), 2012-2014.DESIGN: We present time-to-event survival analysis and Cox proportional hazards regression. Identity numbers were matched to the National Vital Statistics Register.RESULTS: Of the 20 653 patients included in the analysis (median age 35 years, interquartile range 2843), over half were male (n = 10 944, 53.0%). Most were human immunodeficiency virus (HIV) positive (n = 14174, 68.9%), most of whom were on antiretroviral therapy (ART; n = 12 471, 88.0%). At 24 months, 4689 patients had died (22.7%); 2072 deaths (44.2%) were reported within 12 weeks of initiating treatment for MDR/RR-TB. From week 12 to week 24, there were 717 deaths/18 048 persons; 59.5% of mortality occurred within the first 24 weeks. During the first 12 weeks, the adjusted hazard rate (aHR) for mortality was highest among patients with a missing baseline culture result (aHR 3.78, 95%CI 2.94-4.86) and among HIV positive, ART-naive patients (aHR 3.40, 95%CI 2.903.99). Patients initiating MDR/RR-TB treatment within 4 weeks of diagnosis had higher mortality than those with delayed initiation (aHR 1.57, 95%CI 1.41-1.75).CONCLUSION: In EDRweb, mortality is highest in the first few weeks after MDR/RR-TB treatment initiation.