Post-treatment Mortality Among Patients With Tuberculosis: A Prospective Cohort Study of 10 964 Patients in Vietnam
Post-treatment Mortality Among Patients With Tuberculosis: A Prospective Cohort Study of 10 964 Patients in Vietnam
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DOI：
10.1093/cid/ciy665
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发表时间：
2019-04-15
影响因子：
11.8
通讯作者：
Marks, G. B.
中科院分区：
文献类型：
--
作者：
Fox, G. J.;Nguyen, V. N.;Marks, G. B.
背景肺结核是导致死亡的主要传染病。要实现世界卫生组织的“消除结核病战略”，就必须大幅降低结核病相关死亡率。“然而，许多国家缺乏准确的死亡率估计，特别是在出院后。本研究旨在确定越南肺结核患者的死亡率，并量化该人群的超额死亡率。我们在越南70家诊所接受涂阳肺结核治疗的成人患者中进行了一项前瞻性队列研究。居住在同一个家庭的人被招募作为对照。参与者接受了重新采访，并在接受8个月标准化方案治疗后至少2年确定了他们的生存率。通过将患者和对照组的识别数据与临床登记联系起来，确定复发的存在。进行了口头尸检。将患者的累积死亡率与对照人群进行比较，调整年龄和性别。我们招募了10964名患者和25707名家庭对照。在入组的结核病患者中，9%的患者在中位随访期2.9年内死亡：342例（3.1%）在治疗期间，637例（5.8%）在出院后。与对照人群相比，结核病患者的标准化死亡率为4.0（95%置信区间为3.7-4.2）。结核病是44.7%的死亡患者的可能死因。接受结核病治疗的患者死亡风险明显升高，特别是在治疗后阶段。降低结核病死亡率的干预措施必须加强对耐药性的早期发现，提高治疗效果，并解决非传染性疾病。
Background. Tuberculosis is the leading infectious cause of death. Steep reductions in tuberculosis-related mortality are required to realize the World Health Organization's "End Tuberculosis Strategy." However, accurate mortality estimates are lacking in many countries, particularly following discharge from care. This study aimed to establish the mortality rate among patients with pulmonary tuberculosis in Vietnam and to quantify the excess mortality in this population.Methods. We conducted a prospective cohort study among adult patients treated for smear-positive pulmonary tuberculosis in 70 clinics across Vietnam. People living in the same households were recruited as controls. Participants were re-interviewed and their survival was established at least 2 years after their treatment with an 8-month standardized regimen. The presence of relapse was established by linking identifying data on patients and controls to clinic registries. Verbal autopsies were performed. The cumulative mortality among patients was compared to that among a control population, adjusting for age and gender.Results. We enrolled 10 964 patients and 25 707 household controls. Among enrolled tuberculosis patients, 9% of patients died within a median follow-up period of 2.9 years: 342 (3.1%) during treatment and 637 (5.8%) after discharge. The standardized mortality ratio was 4.0 (95% confidence interval 3.7-4.2) among patients with tuberculosis, compared to the control population. Tuberculosis was the likely cause of death for 44.7% of these deceased patients.Conclusions. Patients treated for tuberculosis had a markedly elevated risk of death, particularly in the post-treatment period. Interventions to reduce tuberculosis mortality must enhance the early detection of drug-resistance, improve treatment effectiveness, and address non-communicable diseases.