乌干达坎帕拉住院的新结核病患者的治疗结果：一项前瞻性队列研究。
Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.
作者信息
Kirenga Bruce J, Levin Jonathan, Ayakaka Irene, Worodria William, Reilly Nancy, Mumbowa Francis, Nabanjja Helen, Nyakoojo Grace, Fennelly Kevin, Nakubulwa Susan, Joloba Moses, Okwera Alphonse, Eisenach Kathleen D, McNerney Ruth, Elliott Alison M, Mugerwa Roy D, Smith Peter G, Ellner Jerrold J, Jones-López Edward C
机构信息
Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Medical Research Council-Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda; School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
出版信息
PLoS One. 2014 Mar 7;9(3):e90614. doi: 10.1371/journal.pone.0090614. eCollection 2014.
BACKGROUND
In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda.
METHODS AND FINDINGS
Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045).
CONCLUSION
Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART.
背景
在大多数资源有限的环境中，新的结核病（TB）患者通常作为门诊患者接受治疗。我们试图调查乌干达坎帕拉一组住院的新结核病患者的住院原因、治疗效果不佳和死亡率的预测因素。
方法与结果
纳入了2003年至2006年间住院的96例新结核病患者，并对其进行了两年的随访。32例未感染艾滋病毒，64例感染艾滋病毒。在未感染艾滋病毒的患者中，住院的最常见原因是卡诺夫斯基评分低（47%）和需要进行诊断评估（25%）。感染艾滋病毒的患者住院通常是由于卡诺夫斯基评分低（72%）、并发疾病（16%）和诊断评估（14%）。11例未感染艾滋病毒的患者死亡（死亡率为每100人年19.7例），而41例感染艾滋病毒的患者死亡（死亡率为每100人年46.9例）。在所有患者中，治疗结果不佳（治疗失败、治疗期间死亡或结局不明）与结核病症状持续时间相关，随着症状持续时间的增加，治疗结果不佳的几率降低。在感染艾滋病毒的患者中，治疗结果不佳还与男性性别（P = 0.004）和年龄（P = 0.034）相关。卡诺夫斯基评分低（风险比=8.93，95%可信区间1.88 - 42.40，P = 0.001）是未感染艾滋病毒患者中与死亡率显著相关的唯一因素。感染艾滋病毒患者的死亡率与CD4和抗逆转录病毒治疗使用的综合变量相关，基线CD4低于200个细胞/微升且未接受抗逆转录病毒治疗的患者比接受抗逆转录病毒治疗的患者死亡风险更高，以及卡诺夫斯基评分低（风险比=2.02，95%可信区间1.02 - 4.01，P = 0.045）。
结论
健康状况不佳是新结核病患者住院的常见原因。本研究中的死亡率非常高，且与晚期艾滋病毒疾病和未使用抗逆转录病毒治疗有关。
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