Walpola H C, Siskind V, Patel A M, Konstantinos A, Derhy P
Queensland Health, Specialised Health Services, Annerley, Queensland, Australia.
Int J Tuberc Lung Dis. 2003 Aug;7(8):742-50.
To review factors associated with TB-related deaths in Queensland, Australia.
Review of data for TB patients dying before treatment completion; demographic and clinico-pathological comparison of TB-related deaths with other notified patients after exclusion of losses to follow-up; matched case-control study of co-morbid conditions in patients under 75 years.
Of 1003 tuberculosis cases notified between 1989 and 1998, 127 died before completing anti-tuberculosis treatment. Tuberculosis was the main cause of death in 53 cases, a significant contributor in 34 and unrelated in 40, giving a TB-related case fatality rate of 8.7%. Decedents were older on average, except among indigenous Australians (IA); age-adjusted case fatality rates did not vary significantly among ethnic groups. Pulmonary and disseminated TB, coexistent malnutrition, renal disease and liver disease increased the risk of death. HIV infection increased the risk of dying, but was uncommon among Queensland cases. Neither sputum smear positivity nor drug resistance was associated with risk of death. Twenty-five TB-related deaths occurred before diagnosis, with significant overrepresentation of IA. Most had serious co-morbidities and symptomatic pulmonary disease. Seven socially or geographically isolated decedents did not access documented health care for tuberculosis.
Fatality was related to older age, disseminated disease and co-morbidity. Dying undiagnosed from tuberculosis was associated with respiratory co-morbidity and social and geographical isolation, mainly in the aged in low TB risk populations and in IA in remote regions.
回顾澳大利亚昆士兰州与结核病相关死亡的影响因素。
对治疗未完成前死亡的结核病患者数据进行回顾；排除失访患者后，对结核病相关死亡患者与其他已通报患者进行人口统计学和临床病理比较；对75岁以下患者的合并症进行配对病例对照研究。
1989年至1998年间通报的1003例结核病病例中，127例在完成抗结核治疗前死亡。53例中结核病是主要死因，34例中是重要死因，40例中与结核病无关，结核病相关病死率为8.7%。除澳大利亚原住民（IA）外，死者平均年龄更大；按年龄调整后的病死率在不同种族间无显著差异。肺结核和播散性结核病、并存的营养不良、肾脏疾病和肝脏疾病增加了死亡风险。HIV感染增加了死亡风险，但在昆士兰州病例中并不常见。痰涂片阳性和耐药性均与死亡风险无关。25例结核病相关死亡发生在诊断之前，IA的比例显著过高。大多数患者有严重的合并症和有症状的肺部疾病。7例社会或地理上孤立的死者未获得结核病的书面医疗服务。
病死率与年龄较大、播散性疾病和合并症有关。未被诊断出结核病而死亡与呼吸道合并症以及社会和地理上的孤立有关，主要发生在结核病低风险人群中的老年人以及偏远地区的IA。
