Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Int J Infect Dis. 2024 Nov;148:107238. doi: 10.1016/j.ijid.2024.107238. Epub 2024 Sep 10.
Although a "multisite" definition of disseminated tuberculosis (DTB) exists, there is limited evidence to support its use. Herein, we sought to generate that evidence.
We evaluated treatment outcomes and reporting requirements against two distinct definitions of DTB in a 15-year population-based cohort of consecutively diagnosed patients with tuberculosis (TB) in Canada. Definitions were combined in a multi-variable logistic regression to determine the risk factors for TB-related death in DTB.
We applied two mutually exclusive definitions of DTB to our data set: 1. "strict" - TB disease associated with a positive TB culture in blood/bone marrow or TB disease associated with a miliary pattern on chest imaging and a positive TB culture or, 2. multisite - TB disease in two or more non-contiguous sites. Among 2877 notified patients with TB, 110 (3.8%) met the strict definition, whereas 168 (5.8%) met the multisite definition. Of all 278 patients with DTB, only 135 (48.6%) were notified as DTB using International Classification of Disease codes and only 66 (23.7%) were classified as DTB by Canada's Public Health Agency. Patients with DTB by either definition were less likely to achieve cure/treatment completion and more likely to die. The risk factors for a fatal outcome included extremes of age, Canadian birth, central nervous system involvement, and HIV co-infection.
Our findings support the combination of a strict and multisite definition of DTB for purposes of reporting consistency and investigational comparability.
虽然存在“多部位”的播散性结核病（DTB）定义，但支持其使用的证据有限。在此，我们试图提供该证据。
我们在加拿大一个 15 年的连续确诊结核病（TB）患者的人群队列中，根据两种不同的 DTB 定义评估了治疗结局和报告要求。将定义组合在多变量逻辑回归中，以确定 DTB 患者中与 TB 相关死亡的风险因素。
我们将两种互斥的 DTB 定义应用于我们的数据集：1. “严格” - 与血液/骨髓中结核培养阳性相关的 TB 疾病或与胸部影像学上的粟粒样改变和结核培养阳性相关的 TB 疾病，2. 多部位 - 两个或多个非连续部位的 TB 疾病。在 2877 例报告的 TB 患者中，有 110 例（3.8%）符合严格定义，而 168 例（5.8%）符合多部位定义。在所有 278 例 DTB 患者中，只有 135 例（48.6%）通过国际疾病分类代码报告为 DTB，只有 66 例（23.7%）被加拿大公共卫生署分类为 DTB。根据任一定义，患有 DTB 的患者更不可能实现治愈/治疗完成，更有可能死亡。致命结局的风险因素包括年龄极端、加拿大出生、中枢神经系统受累和 HIV 合并感染。
我们的发现支持将严格和多部位 DTB 定义结合起来，以实现报告一致性和研究可比性。
