Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan.
Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
Sci Rep. 2021 Apr 9;11(1):7840. doi: 10.1038/s41598-021-87332-6.
After traumatic brain injury (TBI), an inflammatory response in the brain might affect the immune system. The risk of pulmonary infection reportedly increases in patients with TBI. We aimed to evaluate the risk of tuberculosis (TB) in patients with TBI in Taiwan. All participants were selected from the intensive care unit (ICU). Patients with TBI were defined as patients in ICU with intracranial injury, and comparison cohort were patients in ICU without TBI diagnosis. There was a significant difference in TB risk between the patients with TBI and the comparison cohort according to age and the Charlson's comorbidity index (CCI) score. Thus, we divided patients based on CCI into three groups for further analysis: mild (CCI = 0), moderate (CCI = 1/2), severe (CCI > 2). Mild-CCI group had a lower TB incidence rate (0.74%) and longer time to TB development (median: 2.43) than the other two groups. Moderate-CCI group had 1.52-fold increased risk of TB infection (p < 0.0001) compared with mild-CCI group. In the severe-CCI group, patients aged ≥ 80 years had 1.91-fold risk of TB compared with mild-CCI group (p = 0.0481). Severe-CCI group had significantly higher mortality than the mild-CCI group (p = 0.0366). Patients with TBI and more comorbidities had higher risk of TB infection with higher mortality rate.
颅脑创伤（TBI）后，大脑中的炎症反应可能会影响免疫系统。据报道，TBI 患者发生肺部感染的风险增加。我们旨在评估台湾 TBI 患者发生结核病（TB）的风险。所有参与者均选自重症监护病房（ICU）。TBI 患者被定义为 ICU 中存在颅内损伤的患者，对照组为 ICU 中无 TBI 诊断的患者。TBI 患者与对照组之间的 TB 风险存在显著差异，与年龄和 Charlson 合并症指数（CCI）评分有关。因此，我们根据 CCI 将患者分为三组进行进一步分析：轻度（CCI=0）、中度（CCI=1/2）、重度（CCI>2）。轻度 CCI 组的 TB 发病率（0.74%）和 TB 发病中位时间（2.43）均低于其他两组。中度 CCI 组的 TB 感染风险比轻度 CCI 组增加 1.52 倍（p<0.0001）。在重度 CCI 组中，年龄≥80 岁的患者与轻度 CCI 组相比，TB 的风险增加了 1.91 倍（p=0.0481）。重度 CCI 组的死亡率明显高于轻度 CCI 组（p=0.0366）。合并症较多的 TBI 患者发生 TB 感染的风险更高，死亡率也更高。
