Wang Ruitong, Jin Long, Cui Haoliang, Zhang Jianyi, Zhang Xinwei, Oyang Kaijun, Wang Zheqi, Jia Zhongwei, Lin Gang
School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, 100191, China.
Infectious Disease Hospital of Heilongjiang Province, No. 1 Jian She Street, Hulan District, Harbin, Heilongjiang, 150500, China.
BMC Infect Dis. 2024 Dec 28;24(1):1471. doi: 10.1186/s12879-024-10369-1.
Tuberculosis (TB) remains a significant global health issue. Drug-resistant TB and comorbidities exacerbate its burden, influencing treatment outcomes and healthcare utilization. Despite the growing prevalence of TB comorbidities, research often focuses on single comorbidities rather than comorbidity patterns. This study aims to evaluate comorbidity patterns among TB inpatients in Northeastern China from 2013 to 2021 and investigate the association between comorbidities and drug-resistance with length of hospital stay (LOS). Our findings could enhance the understanding of TB comorbidity interactions and provide evidence for targeted morbidity management strategies.
Network analysis was used to evaluate comorbidity patterns, estimating centrality indices to understand the structural importance of each comorbidity. The Walktrap algorithm was used to identify clusters of highly connected comorbidities. Networks of drug-susceptible and drug-resistant TB inpatients were compared. Multivariable linear regression models were used to assess the associations between LOS with comorbidities and drug resistance.
A total of 2,352 TB inpatients were included, with a median LOS of 31 (IQR: 16-51) days. Inpatients with multidrug-resistant TB (β = 12.88, 95%CI = 8.03-17.73), chronic hepatitis C (β = 31.89, 95%CI: 4.41-59.37), pneumonia (β = 37.14, 95%CI: 12.53 - 61.76), pneumoconiosis (β = 28.40, 95%CI: 11.92 - 44.87), pneumothorax (β = 19.88, 95%CI: 4.97 - 34.80), and dermatitis/eczema (β = 56.54, 95%CI: 8.18 - 104.89) were significantly associated with longer LOS. Frequent comorbidities included liver dysfunction(15.2%), hypoproteinemia (14.4%), diabetes (14.2%), pleural effusion (11.3%), and emphysema (10.2%). Hypoproteinemia showed high structural importance in the network, ranking second in strength and highest in betweenness. Nine clusters of comorbidities were detected. No significant differences were found between the networks of drug-sensitive and drug-resistant TB inpatients, except for the greater strength of cholecystitis among drug-resistant inpatients.
Early detection and management of drug-resistant TB and comorbidities that prolong LOS, as well as those with structural importance or within the same cluster in the comorbidity network, are crucial for improving patient outcomes.
结核病仍然是一个重大的全球健康问题。耐药结核病和合并症加剧了其负担，影响治疗结果和医疗资源利用。尽管结核病合并症的患病率不断上升，但研究往往集中在单一合并症而非合并症模式上。本研究旨在评估2013年至2021年中国东北地区结核病住院患者的合并症模式，并调查合并症和耐药性与住院时间（LOS）之间的关联。我们的研究结果可以增进对结核病合并症相互作用的理解，并为针对性的发病管理策略提供证据。
采用网络分析评估合并症模式，估计中心性指标以了解每种合并症的结构重要性。使用Walktrap算法识别高度关联的合并症集群。比较药物敏感和耐药结核病住院患者的网络。使用多变量线性回归模型评估LOS与合并症和耐药性之间的关联。
共纳入2352例结核病住院患者，中位LOS为31（IQR：16 - 51）天。耐多药结核病患者（β = 12.88，95%CI = 8.03 - 17.73）、慢性丙型肝炎患者（β = 31.89，95%CI：4.41 - 59.37）、肺炎患者（β = 37.14，95%CI：12.53 - 61.76）、尘肺病患者（β = 28.40，95%CI：11.92 - 44.87）、气胸患者（β = 19.88，95%CI：4.97 - 34.80）和皮炎/湿疹患者（β = 56.54，95%CI：8.18 - 104.89）的LOS显著延长。常见合并症包括肝功能障碍（15.2%）、低蛋白血症（14.4%）、糖尿病（14.2%）、胸腔积液（11.3%）和肺气肿（10.2%）。低蛋白血症在网络中显示出较高的结构重要性，强度排名第二，中介中心性最高。检测到九个合并症集群。除耐药住院患者胆囊炎的强度更大外，药物敏感和耐药结核病住院患者的网络之间未发现显著差异。
早期发现和管理耐药结核病以及延长LOS的合并症，以及合并症网络中具有结构重要性或属于同一集群的合并症，对于改善患者预后至关重要。
