A systematic review of risk factors for mortality among tuberculosis patients in South Africa.
A systematic review of risk factors for mortality among tuberculosis patients in South Africa.
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对南非结核病患者死亡危险因素的系统回顾。
DOI：
10.1186/s13643-023-02175-8
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发表时间：
2023-02-23
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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作者：
南非的结核病相关死亡率仍然很高。本综述旨在系统评估南非患者结核病治疗期间死亡相关的风险因素。我们对2010年至2018年期间发表的结核病研究文章进行了系统综述。我们检索了BioMed Central（BMC）、PubMed®、EBSCOhost、科克伦和SCOPUS中2010年1月至2018年12月期间的出版物。于2019年8月至2019年10月期间进行测试。我们纳入了随机对照试验（RCT）、病例对照、横断面、回顾性和前瞻性队列研究，其中TB死亡率是主要终点，并提供了TB治疗期间TB死亡率风险因素的效应测量估计值。由于评估的效应指标和风险因素的异质性，对结核病死亡率的风险因素进行正式的荟萃分析是不合适的。随机效应荟萃分析用于估计所有研究和特定亚组的病死率（CFR），以便进行比较。使用Newcastle-Ottawa量表或科克伦偏倚风险工具进行质量评估。我们确定了1995个标题进行筛选，24篇出版物符合我们的纳入标准（1项横断面研究，2项RCT和21项队列研究）。22项研究报告了成人（n = 12561），2项研究仅限于< 15岁的儿童（n = 696）。所有研究的CFR估计值为26.4%（CI 18.1-34.7，n = 13257）; 37.5%（CI 24.8-50.3，n = 5149）耐药（DR）TB; 12.5%（CI 1.1-23.9，n = 1935）药物敏感（DS）TB; 15.6%（CI 8.1-23.2，n = 6173）对于药物敏感性混合或未指明的研究; 21.3%在HIV/AIDS患者（PLHIV）中为19.2%（CI 15.3-27.3，n = 7375）;在HIV阴性TB患者中为19.2%（CI 7.7-30.7，n = 1691）;在儿科研究中为6.8%（CI 4.9-8.7，n = 696）。与结核病死亡率相关的主要危险因素是艾滋病毒感染、既往结核病治疗、耐药结核病和结核病诊断时体重较低。在南非，结核病治疗期间的总体死亡率仍然很高，耐药结核病患者在结核病治疗期间的死亡风险较高，需要采取干预措施降低高死亡率。此外，还需要更好的结核病死亡率前瞻性数据，特别是在包括幼儿、青少年、孕妇和患有艾滋病毒以外的合并症的人群在内的脆弱亚人群中。局限性包括缺乏前瞻性研究和随机对照试验，以及风险因素和对照变量的高度异质性。该系统性综述方案已在国际系统性综述前瞻性登记系统（PROSPERO）中注册，注册号为CRD 42018108622。这项研究由比尔和梅林达盖茨基金会（投资ID OPP 1173131）通过南非结核病智库资助。在线版本包含补充材料，可通过10.1186/s13643-023-02175-8获得。
Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1–34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1–23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1–23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7–30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9–8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank. The online version contains supplementary material available at 10.1186/s13643-023-02175-8.
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DOI：
10.1093/cid/cix254
发表时间：
2017-07-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
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作者：
Janssen S;Schutz C;Ward A;Nemes E;Wilkinson KA;Scriven J;Huson MA;Aben N;Maartens G;Burton R;Wilkinson RJ;Grobusch MP;Van der Poll T;Meintjes G
通讯作者：
Meintjes G
DOI：
10.7196/samj.2019.v109i10.14073
发表时间：
2019-10-01
期刊：
SAMJ: South African Medical Journal
影响因子：
--
作者：
Loveday, M;Mzobe, Y N;Barron, P
通讯作者：
Barron, P
DOI：
10.1056/nejmoa0905848
发表时间：
2010-02-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Abdool Karim SS;Naidoo K;Grobler A;Padayatchi N;Baxter C;Gray A;Gengiah T;Nair G;Bamber S;Singh A;Khan M;Pienaar J;El-Sadr W;Friedland G;Abdool Karim Q
通讯作者：
Abdool Karim Q
影响因子：
3.7
作者：
Field N;Lim MS;Murray J;Dowdeswell RJ;Glynn JR;Sonnenberg P
通讯作者：
Sonnenberg P
DOI：
10.4084/mjhid.2010.005
发表时间：
2010-04-20
影响因子：
3.2
作者：
Khalafallah A;Maiwald M;Cox A;Burns D;Bates G;Hannan T;Seaton D;Fernandopulle B;Meagher D;Brain T
通讯作者：
Brain T