Fielder J F, Chaulk C P, Dalvi M, Gachuhi R, Comstock G W, Sterling T R
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore 21231, USA.
Int J Tuberc Lung Dis. 2002 Dec;6(12):1114-7.
Worldwide, the case-fatality rate of smear-positive pulmonary tuberculosis among persons on treatment is 3.8%. We assessed the case-fatality rate among such patients in Baltimore between January 1993 and June 1998. Tuberculosis incidence was < 17/100 000 population, and 99% of patients received directly observed therapy. Of 174 patients, 42 (24%) died on treatment. Patients who died were older (mean age 62 vs. 47 years; P < 0.001) and were more likely to have underlying medical conditions. In multivariate analyses, older age, diabetes mellitus, and renal failure were independently associated with an increased risk of death. With effective control, tuberculosis may become concentrated in older persons with chronic diseases and be associated with high case-fatality rates. In such settings, acceptable treatment success rates may need to be revised.
在全球范围内，接受治疗的涂片阳性肺结核患者的病死率为3.8%。我们评估了1993年1月至1998年6月期间巴尔的摩此类患者的病死率。结核病发病率低于17/10万人口，99%的患者接受了直接观察治疗。在174例患者中，42例（24%）在治疗期间死亡。死亡患者年龄较大（平均年龄62岁对47岁；P<0.001），且更有可能有基础疾病。在多变量分析中，年龄较大、糖尿病和肾衰竭与死亡风险增加独立相关。随着有效控制，结核病可能集中在患有慢性病的老年人中，并与高病死率相关。在这种情况下，可能需要修订可接受的治疗成功率。
