Epidemiology Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
PLoS One. 2011 Apr 8;6(4):e18474. doi: 10.1371/journal.pone.0018474.
Weight variation during therapy has been described as a useful marker to predict TB treatment outcome. No previous study has used longitudinal analysis to corroborate this finding. The goal of this study was to evaluate change and trends of patients' bodyweight over time depending on TB treatment outcome.
A retrospective cohort study with all TB cases diagnosed from 2000 to 2006 was carried out. Information from 5 public tuberculosis treatment facilities at Pampas de San Juan de Miraflores, Lima, Peru was analyzed. Poor outcome was defined as failure or death during TB therapy, and compared to good outcome defined as cured. Longitudinal analysis with a pre-specified marginal model was fitted using Generalized Estimating Equations to compare weight trends for patients with good and poor outcome adjusting for potential confounders. A total of 460 patients (55.4% males, mean age: 31.6 years) were included in the analysis: 42 (9.1%) had a poor outcome (17 failed and 25 died). Weight at baseline was not different comparing outcome groups (p = 0.17). After adjusting for age, gender, type of TB, scheme of treatment, HIV status and sputum variation during follow-up, after the first month of treatment, patients with good outcome gained, on average, almost 1 kg compared to their baseline weight (p<0.001), whereas those with poor outcome lost 1 kg (p = 0.003). Similarly, after 4 months, a patient with good outcome increased 3 kg on average (p<0.001), while those with poor outcome only gained 0.2 kg (p = 0.02).
Weight variation during tuberculosis therapy follow-up can predict treatment outcome. Patients losing weight during TB treatment, especially in the first month, should be more closely followed as they are at risk of failure or death.
治疗期间的体重变化已被描述为预测结核病治疗结局的有用标志物。以前没有研究使用纵向分析来证实这一发现。本研究的目的是评估患者体重随时间的变化和趋势，根据结核病治疗结局而定。
开展了一项回顾性队列研究，纳入了 2000 年至 2006 年间诊断的所有结核病病例。分析了秘鲁利马米拉弗洛雷斯潘帕斯的 5 家公共结核病治疗机构的信息。不良结局定义为结核病治疗期间失败或死亡，并与治愈定义的良好结局进行比较。使用广义估计方程拟合了具有预先指定的边缘模型的纵向分析，以比较良好和不良结局患者的体重趋势，调整了潜在混杂因素。共纳入 460 例患者（55.4%为男性，平均年龄 31.6 岁）：42 例（9.1%）发生不良结局（17 例失败，25 例死亡）。在比较结局组时，基线体重没有差异（p = 0.17）。在校正年龄、性别、结核病类型、治疗方案、HIV 状态和随访期间的痰量变化后，在治疗的第一个月，与基线体重相比，结局良好的患者平均增加了近 1 公斤（p<0.001），而结局不良的患者体重减轻了 1 公斤（p = 0.003）。同样，在 4 个月后，与基线体重相比，结局良好的患者平均增加了 3 公斤（p<0.001），而结局不良的患者仅增加了 0.2 公斤（p = 0.02）。
结核病治疗随访期间的体重变化可以预测治疗结局。在结核病治疗过程中体重减轻的患者，特别是在第一个月，应更密切地监测，因为他们有失败或死亡的风险。
