Factors related to in-hospital deaths in patients with tuberculosis
Factors related to in-hospital deaths in patients with tuberculosis
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DOI：
10.1001/archinte.158.17.1916
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发表时间：
1998-09-28
影响因子：
--
通讯作者：
Pendle, S
中科院分区：
文献类型：
--
作者：
Sacks, LV;Pendle, S
背景：尽管有有效的抗菌药物，但结核病（TB）死亡仍在继续发生。多药耐药，人类免疫缺陷病毒（HIV）感染，和延迟治疗已经implicated.Objective：探讨与活动性TB.Methods患者住院死亡相关的临床因素：一项回顾性病例对照研究是在南非约翰内斯堡的一家政府医院收治的患者，作为结核病患者的转诊中心。80例在住院期间死亡的结核病患者与80例在住院期间幸存的类似结核病患者相匹配。结果：住院死亡率与女性性别（P = 0.01）、入院时较低的血红蛋白水平（P <0.01）和体重（P <0.01）以及胸片上更广泛的浸润性模式的趋势相关。出乎意料的是，多药耐药、肺外疾病和HIV感染与住院死亡率无关。入院后第一周的高死亡率表明，晚期就诊是院内死亡的主要因素。HIV感染者的耐药性低于HIV阴性者（P = 0.07），胸部X线片上的浸润程度相同，但空洞和纤维化程度较低（P <0.01）。结论：结核病早期死亡的临床预测因素包括贫血、低体重和广泛浸润;而多药耐药和HIV感染不是重要因素。以前暴露于结核病和延迟出现可能会影响我们的研究结果。由于患者在疾病晚期出现，积极的病例发现对于控制这一人群的结核病非常重要。
Background: Deaths from tuberculosis (TB) continue to occur despite the availability of effective antimicrobial agents. Multidrug resistance, human immunodeficiency virus (HIV) infection, and delayed therapy have been implicated.Objective: To examine clinical factors associated with in-hospital death in patients with active TB.Methods: A retrospective case-control study was per formed on patients admitted to a government hospital in Johannesburg, South Africa, used as a referral center for patients with TB. Eighty patients admitted with TB who died during hospitalization were matched with 80 similar patients with TB who survived hospitalization. Clinical, demographic, and radiological characteristics of each group were compared.Results: In-hospital fatalities were associated with female sex (P = .01), lower admission hemoglobin level (P < .01), and weight (P < .01), and a trend to more extensive infiltrative patterns on chest radiographs. Multidrug resistance, extrapulmonary disease, and HIV infection were unexpectedly not related to in-hospital mortality. High mortality in the first weeks of admission suggested that late presentation was a major factor for in-hospital death. The HIV-infected participants in the study showed less drug resistance than HIV-negative patients (P = .07), equivalent extents of infiltrative patterns on chest radiographs, but much less cavitation and fibrosis (P < .01).Conclusions: Clinical predictors of early mortality from TB included anemia, low body weight, and extensive infiltrates; while multidrug resistance and HIV infection were not significant factors. Previous exposure to TB and delayed presentation may have influenced our findings. Since patients present late in their illness, aggressive case finding would be important in controlling TB in this population.