Tonko S, Baty F, Brutsche M H, Schoch O D
Lung Centre, Department of Pneumology and Sleep Medicine, Cantonal Hospital St Gallen, St Gallen.
Lung Centre, Department of Pneumology and Sleep Medicine, Cantonal Hospital St Gallen, St Gallen, Tuberculosis Competence Centre, Swiss Lung Association, Berne, Switzerland.
Int J Tuberc Lung Dis. 2020 Sep 1;24(9):948-955. doi: 10.5588/ijtld.19.0759.
Although most guidelines overwhelmingly recommend outpatient TB treatment, hospitalisations are common. We investigated the proportion of TB patients hospitalised and determined factors associated with length of stay (LOS) in Switzerland. Cases with TB as the primary diagnosis were retrieved from a nation-wide hospitalisation database and compared to TB notifications. Month and year of admission, hospital site, type of TB, age, sex, LOS and up to 50 ICD-10 coded comorbidities were compared with controls matched for age, sex and admission date. From 2002 to 2015, the estimated TB hospitalisation rate was 81%. The median LOS of 6,234 TB patients was stable at 14 days (IQR 6-22), but increased in patients with miliary TB, old patients and with hospital location. TB-associated comorbidities included HIV, liver disease, anaemia, malnutrition and genitourinary tract diseases. LOS was associated with three comorbidity clusters: 1) malnutrition, cachexia and anaemia (median LOS 20 days, IQR 13-31); 2) toxic liver disease and hepatitis (median LOS 23 days, IQR 14-37.5); and 3) adverse drug events (median LOS 20 days, IQR 13-30). Most TB patients were hospitalised. LOS was related to TB type, comorbidities and hospital location. Promoting outpatient care is a priority to improve TB management in Switzerland.
尽管大多数指南极力推荐肺结核门诊治疗，但住院治疗仍很常见。我们调查了瑞士肺结核患者的住院比例，并确定了与住院时间相关的因素。以肺结核作为主要诊断的病例从全国住院数据库中检索出来，并与肺结核通报数据进行比较。将入院月份和年份、医院地点、肺结核类型、年龄、性别、住院时间以及多达50种按国际疾病分类第十版（ICD - 10）编码的合并症与按年龄、性别和入院日期匹配的对照组进行比较。2002年至2015年期间，估计的肺结核住院率为81%。6234例肺结核患者的住院时间中位数稳定在14天（四分位间距为6 - 22天），但粟粒性肺结核患者、老年患者以及不同医院地点的患者住院时间有所增加。与肺结核相关的合并症包括艾滋病毒感染、肝病、贫血、营养不良和泌尿生殖道疾病。住院时间与三个合并症集群相关：1）营养不良、恶病质和贫血（住院时间中位数为20天，四分位间距为13 - 31天）；2）中毒性肝病和肝炎（住院时间中位数为23天，四分位间距为14 - 37.5天）；3）药物不良反应（住院时间中位数为20天，四分位间距为13 - 30天）。大多数肺结核患者需要住院治疗。住院时间与肺结核类型、合并症和医院地点有关。在瑞士，促进门诊治疗是改善肺结核管理的一项优先任务。
