喀麦隆雅温得中心医院HIV合并感染患者结核病治疗期间死亡的相关因素：一项基于医院的8年回顾性队列研究（2006 - 2013年）
Factors associated with death during tuberculosis treatment of patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon: an 8-year hospital-based retrospective cohort study (2006-2013).
作者信息
Agbor Ako A, Bigna Jean Joel R, Billong Serges Clotaire, Tejiokem Mathurin Cyrille, Ekali Gabriel L, Plottel Claudia S, Noubiap Jean Jacques N, Abessolo Hortence, Toby Roselyne, Koulla-Shiro Sinata
机构信息
Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, P.O. Box 1364, Yaoundé, Cameroon.
Goulfey Health District Unit, Ministry of Public Health, P.O. Box 62 Kousséri, Goulfey, Cameroon.
出版信息
PLoS One. 2014 Dec 15;9(12):e115211. doi: 10.1371/journal.pone.0115211. eCollection 2014.
BACKGROUND
Contributors to fatal outcomes in TB/HIV co-infected patients actively undergoing TB treatment are poorly characterized. The aim was to assess factors associated with death in TB/HIV co-infected patients during the initial 6 months of TB treatment.
METHODS
We conducted a hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization's recommendations. We conducted logistic regression analysis to identify factors associated with a fatal outcome. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval.
RESULTS
The 337 patients enrolled had a mean age of 39.3 (standard deviation 10.3) years and 54.3% were female. TB treatment outcomes were distributed as follows: 205 (60.8%) treatment success, 99 (29.4%) deaths, 18 (5.3%) not evaluated, 14 (4.2%) lost to follow-up, and 1 (0.3%) failed. After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with a TB diagnosis made before 2010 (aOR = 2.50 [1.31-4.78]; p = 0.006), the presence of other AIDS-defining diseases (aOR = 2.73 [1.27-5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37-8.21]; p = 0.008), not receiving cotrimoxazole prophylaxis (aOR = 3.61 [1.71-7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18-5.08]; p = 0.016), and CD4 cells count <50 cells/mm3 (aOR = 16.43 [1.05-258.04]; p = 0.047).
CONCLUSIONS
The TB treatment success rate among TB/HIV co-infected patients in our setting is low. Mortality was high among TB/HIV co-infected patients during TB treatment and is strongly associated with clinical and biological factors, highlighting the urgent need for specific interventions focused on enhancing patient outcomes.
背景
积极接受结核病治疗的结核病/艾滋病合并感染患者的死亡因素尚未得到充分描述。目的是评估结核病/艾滋病合并感染患者在结核病治疗最初6个月内与死亡相关的因素。
方法
2006年1月至2013年12月，我们在喀麦隆雅温得中心医院开展了一项基于医院的回顾性队列研究。我们查阅医疗记录，以确定15岁及以上住院的结核病/艾滋病合并感染患者。根据世界卫生组织的建议，死亡定义为结核病治疗期间发生的任何死亡。我们进行逻辑回归分析，以确定与致命结局相关的因素。关联强度用调整后的优势比（aOR）及95%置信区间表示。
结果
纳入的337例患者平均年龄为39.3（标准差10.3）岁，54.3%为女性。结核病治疗结果分布如下：205例（60.8%）治疗成功，99例（29.4%）死亡，18例（5.3%）未评估，14例（4.2%）失访，1例（0.3%）治疗失败。排除失访和未评估的患者后，结核病/艾滋病合并感染患者在结核病治疗期间的死亡与2010年前确诊结核病（aOR = 2.50 [1.31 - 4.78]；p = 0.006）、存在其他艾滋病定义疾病（aOR = 2.73 [1.27 - 5.86]；p = 0.010）、非艾滋病合并症（aOR = 3.35 [1.37 - 8.21]；p = 0.008）、未接受复方新诺明预防性治疗（aOR = 3.61 [1.71 - 7.63]；p = 0.001）、未接受抗逆转录病毒治疗（aOR = 2.45 [1.18 - 5.08]；p = 0.016）以及CD4细胞计数<50个细胞/mm³（aOR = 16.43 [1.05 - 258.04]；p = 0.047）相关。
结论
我们研究中结核病/艾滋病合并感染患者的结核病治疗成功率较低。结核病/艾滋病合并感染患者在结核病治疗期间死亡率较高，且与临床和生物学因素密切相关，这突出表明迫切需要采取针对性干预措施以改善患者结局。
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