Yamana H, Matsui H, Fushimi K, Yasunaga H
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Bunkyo City Public Health Center, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Int J Tuberc Lung Dis. 2015 Jan;19(1):120-6. doi: 10.5588/ijtld.14.0333.
Although standardised multidrug treatments exist, mortality among hospitalised tuberculosis (TB) patients is high.
To characterise TB patients requiring acute hospital care and identify factors associated with in-hospital mortality.
Using a Japanese national database of acute-care hospitals, we identified patients with sputum smear-positive pulmonary TB who were discharged (both deceased and alive) between July 2010 and March 2013. Demographic characteristics, comorbidity, procedures and treatments were examined. We performed a multivariable logistic regression analysis to identify risk factors for in-hospital mortality.
Of 877 treated patients (566 males, mean age 74.5 years) identified, 152 (17.3%) died. A standard four-drug regimen of isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and pyrazinamide was given to 279 (31.8%) patients, and INH, RMP and EMB to 335 (38.2%) patients. Multivariable analysis showed that the three-drug regimen was significantly associated with higher rates of in-hospital mortality (OR 1.87, 95%CI 1.07-3.27, P = 0.028). Other factors associated with in-hospital death were age, male sex, smoking habit, emergency admission, dementia and severe respiratory condition.
The risk factors for in-hospital death identified include the use of the three-drug regimen. Treatment choice could influence the outcome of hospitalised TB patients.
尽管存在标准化的多药治疗方案，但住院结核病患者的死亡率依然很高。
描述需要急性住院治疗的结核病患者特征，并确定与院内死亡率相关的因素。
利用日本全国急性护理医院数据库，我们识别出2010年7月至2013年3月期间出院（包括死亡和存活）的痰涂片阳性肺结核患者。对人口统计学特征、合并症、诊疗程序和治疗方法进行了检查。我们进行了多变量逻辑回归分析，以确定院内死亡的危险因素。
在识别出的877例接受治疗的患者（566例男性，平均年龄74.5岁）中，152例（17.3%）死亡。279例（31.8%）患者接受了异烟肼（INH）、利福平（RMP）、乙胺丁醇（EMB）和吡嗪酰胺的标准四联方案，335例（38.2%）患者接受了INH、RMP和EMB治疗。多变量分析显示，三联方案与较高的院内死亡率显著相关（比值比1.87，95%置信区间1.07 - 3.27，P = 0.028）。与院内死亡相关的其他因素包括年龄、男性、吸烟习惯、急诊入院、痴呆和严重呼吸状况。
已确定的院内死亡危险因素包括使用三联方案。治疗选择可能会影响住院结核病患者的治疗结果。
