Shamaei Masoud, Samiei-Nejad Mozhgan, Nadernejad Masoumeh, Baghaei Parvaneh
1 Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J STD AIDS. 2017 Oct;28(12):1169-1174. doi: 10.1177/0956462417691442. Epub 2017 Feb 6.
Tuberculosis (TB) is still a major health problem and TB hospital readmission could increase health system costs. In a retrospective study in a tertiary referral hospital for TB in Tehran, Iran, TB patients with readmission were evaluated. These TB patients in the index year who were then readmitted were compared with TB patients in the same year who were not readmitted during the follow-up period. One hundred and forty-six patients had hospital readmission within three-year follow-up with mean age of 51.6 years old of whom 78 patients (53.5%) were men. Univariate analysis revealed married status, smoking, opium smoking, and medical comorbidities (chronic obstructive pulmonary disease [COPD], hypertension, and human immunodeficiency virus [HIV] infection) as risk factors. Final logistic regression model revealed married status and smoking values of (0.478 odds ratio [OR], 0.310-0.737; 95% confidence interval [CI], P = 0.001) and (1.932 OR, 1.269-2.941; 95% CI, P = 0.002), respectively. Readmission predicted probability was 37% for married patients and 31% for active smokers. The most common medical comorbidities in the first readmission were COPD and HIV infection. Dyspnea and anti-TB drug-induced hepatitis were a common cause of early readmission, while failure and default of treatment were more frequent causes of late readmission. Admission and discharge guidelines, outpatient follow-up, and smoking cessation intervention were proposed as important factors in decreasing the readmission rate.
结核病（TB）仍然是一个主要的健康问题，结核病患者再次入院可能会增加卫生系统成本。在伊朗德黑兰一家三级结核病转诊医院进行的一项回顾性研究中，对再次入院的结核病患者进行了评估。将索引年份中随后再次入院的结核病患者与同年随访期间未再次入院的结核病患者进行了比较。146例患者在三年随访期内再次入院，平均年龄51.6岁，其中78例（53.5%）为男性。单因素分析显示婚姻状况、吸烟、吸食鸦片和合并症（慢性阻塞性肺疾病[COPD]、高血压和人类免疫缺陷病毒[HIV]感染）为危险因素。最终的逻辑回归模型显示婚姻状况和吸烟的比值比（OR）分别为（0.478，0.310 - 0.737；95%置信区间[CI]，P = 0.001）和（1.932，1.269 - 2.941；95% CI，P = 0.002）。已婚患者再次入院预测概率为37%，现吸烟者为31%。首次再次入院时最常见的合并症是COPD和HIV感染。呼吸困难和抗结核药物性肝炎是早期再次入院的常见原因，而治疗失败和中断则是晚期再次入院更常见的原因。提出入院和出院指南、门诊随访和戒烟干预是降低再次入院率的重要因素。
