Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia.
Risk factors for mortality among adult patients with newly diagnosed tuberculosis in Samara, Russia.
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发表时间：
2006-11
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通讯作者：
E. Kourbatova;B. Borodulin;E. Borodulina;C. del Rio;H. Blumberg;M. Leonard
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作者：
E. Kourbatova;B. Borodulin;E. Borodulina;C. del Rio;H. Blumberg;M. Leonard
单位：俄罗斯萨马拉的5个结核病门诊和1个结核病住院医院。目的确定新诊断结核病患者全因死亡率的预测因素。设计：对1999 ~ 2003年5年间登记的成人肺结核病例进行回顾性病例对照研究，采用多因素Logistic回归模型。病例定义为在诊断后12个月内死亡的结核病患者。对照组是存活至少12个月的结核病患者。结果病死率为3.6%。共确定了92例病例和368例对照。平均年龄为43岁; 71%为男性; 4%为人类免疫缺陷病毒（HIV）血清阳性。中位生存期为39.5天。在多变量分析中，死亡率的独立预测因素包括双侧肺受累（OR 3.65），胸部X线片（CXR）上的空洞性病变（OR 2.45），诊断时症状>4周（OR 2.62），贫血（OR 5.24）和注射毒品（IDU）（OR 4.45），控制年龄。结论在萨马拉，诊断时的晚期结核病（表现为双侧肺受累、空洞性疾病、症状>1个月和贫血）和IDU与结核病死亡率增加相关。旨在改善结核病早期诊断和治疗的干预措施可能有助于降低该地区结核病患者的死亡率。
SETTING Five out-patient tuberculosis (TB) clinics and one in-patient TB hospital in Samara, Russia. OBJECTIVE To identify predictors of all-cause mortality among patients with newly diagnosed TB. DESIGN A retrospective case-control study of adult TB cases registered over a 5-year period from 1999 to 2003 using multivariate logistic regression modeling. Cases were defined as patients with TB who died within 12 months of diagnosis. Controls were patients with TB who survived at least 12 months. RESULTS The case fatality rate was 3.6%. A total of 92 cases and 368 controls were identified. Mean age was 43 years; 71% were male; 4% were human immunodeficiency virus (HIV) seropositive. The median survival time for cases was 39.5 days. In multivariate analysis, independent predictors of mortality included bilateral lung involvement (OR 3.65), cavitary lesions on chest radiograph (CXR) (OR 2.45), symptoms >4 weeks at the time of diagnosis (OR 2.62), anemia (OR 5.24), and injection drug use (IDU) (OR 4.45), controlling for age. CONCLUSION Advanced TB disease at the time of diagnosis (as demonstrated by having bilateral lung involvement, cavitary disease, symptoms >1 month, and anemia) and IDU were associated with increased TB mortality in Samara. Interventions targeted at improving earlier TB case diagnosis and treatment may help to reduce mortality among patients with tuberculosis in this region.