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Thorax:伴有结核的危重病人诊断、治疗及预后

2022-08-23 MedSci原创 MedSci原创

入住ICU的结核病患者的生存率在过去十年中没有改善,死亡率仍然很高。延误结核病治疗与较高的医院死亡率相关。

结核病是一种可预防和可治愈的疾病,但结核病引起的败血症和严重疾病的死亡率仍然很高。近日,胸部疾病领域权威杂志Thorax上发表了一篇研究文章,这是一项以人群为基础的多中心回顾性队列研究,研究对象为2008年4月1日至2019年3月31日期间中国香港15家公立医院所有入住重症监护室(ICU)的成年患者。

在133858名ICU住院患者中,940名成人重症患者至少有1例结核分枝杆菌培养结果为阳性。研究人员采用广义线性模型来确定结核病治疗延迟对医院死亡率的影响。此外,研究人员采用Mann-Kendall趋势检验分析了11年期间年度急性生理学和慢性健康评估(APACHE)IV调整标准化死亡率(SMR)的趋势。

研究人员发现ICU病死率为24.7%(232/940),住院病死率为41.1%(386/940)。在ICU的死亡患者中,22.8%(53/232)从未接受过抗结核药物治疗。ICU患者结核的SMR在研究期间保持不变(Kendall'sτb=0.37,p=0.876)。调整年龄后,Charlson共病指数、APACHEIV、白蛋白、血管升压药物、机械通气和肾替代治疗、延迟结核治疗与医院死亡率直接相关。在302/940(32.1%)的患者中,由于Ziehl-Neelsen染色或PCR未进行或阴性,仅通过结核分枝杆菌培养就能明确为结核。在这个组别中,只有31.1%(94/302)的患者同时进行了结核分枝杆菌PCR检查。

由此可见,入住ICU的结核病患者的生存率在过去十年中没有改善,死亡率仍然很高。延误结核病治疗与较高的医院死亡率相关。使用结核分枝杆菌PCR检查可提高诊断率和促进早期治疗。

原始出处:

Christina So,et al.Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis in Hong Kong (2008–2018).Thorax.2022.https://thorax.bmj.com/content/early/2022/08/17/thorax-2022-218868

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    预测模型牛x

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