Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Predictors on In-hospital Mortality Following In-hospital Diagnosis of Tuberculosis

결핵으로 입원한 환자의 병원내 사망과 관련된 인자

  • Shin, Su Rin (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Kim, Chang Hwan (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Kim, Sung Eun (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Park, Yong Bum (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Lee, Jae Young (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Mo, Eun Kyung (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Kim, Cheol Hong (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Eom, Kwang Seok (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Jang, Seung Hun (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Kim, Dong Gyu (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Lee, Myung Gu (Department of Internal Medicine, College of Medicine, Hallym University) ;
  • Jung, Ki Suck (Department of Internal Medicine, College of Medicine, Hallym University)
  • 신수린 (한림대학교 의과대학 내과학교실) ;
  • 김창환 (한림대학교 의과대학 내과학교실) ;
  • 김성은 (한림대학교 의과대학 내과학교실) ;
  • 박용범 (한림대학교 의과대학 내과학교실) ;
  • 이재영 (한림대학교 의과대학 내과학교실) ;
  • 모은경 (한림대학교 의과대학 내과학교실) ;
  • 김철홍 (한림대학교 의과대학 내과학교실) ;
  • 엄광석 (한림대학교 의과대학 내과학교실) ;
  • 장승훈 (한림대학교 의과대학 내과학교실) ;
  • 김동규 (한림대학교 의과대학 내과학교실) ;
  • 이명구 (한림대학교 의과대학 내과학교실) ;
  • 정기석 (한림대학교 의과대학 내과학교실)
  • Received : 2006.04.18
  • Accepted : 2006.08.30
  • Published : 2006.09.30
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Abstract

Study objectives: To determine the factors associated with mortality after an in-hospital diagnosis of tuberculosis in a region with low levels of HIV coinfection. Methods: From January 2003 to December 2004, all subjects who were > 15 years of age and had received a diagnosis of tuberculosis were registered. The clinical, radiological and laboratory aspects of the patients who died (n=27) were compared with those of an age and gender matched control population(n=54). Logistic regression analyses were carried out, which included age, gender, hospital admission source, initial site of admission, dyspnea, general weakness and initial laboratory data. Results: The mean age of the patients was $60{\pm}16$ years and male patients outnumbered female patients. Univariate analysis identified hemoglobin, blood urea nitrogen, albumin, cholesterol, aspartate aminotransferase (AST), C-reactive protein and the risk factors for tuberculosis to be significantly associated with mortality. Among the characteristics of disease presentation and treatment, emergency department admission, intensive care unit, disease severity, general weakness and dyspnea at the time of admission were associated with mortality. Multiple regression analysis revealed the initial management in the intensive care unit and lower serum albumin to be independently associated with mortality. Conclusion: The markers of disease chronicity and severity appear to be associated with in-hospital mortality. Identifying potentially reversible factors such as malnutrition and respiratory failure suggests specific intervention that might lead to an improvement in the patients' outcomes.

배 경: 근치적 항결핵제의 유용에도 불구하고, 결핵으로 사망하는 환자는 증가하고 있다. 다제내성결핵과 HIV 감염이 높은 사망률과 관련되어 있지만, HIV 감염률이 낮은 지역에서는 다른 요소들이 사망과 관련되어 있을 가능성이 있다. 이에 결핵으로 입원한 환자에서 병원내 사망과 관련된 인자들을 알아보고자 하였다. 방 법: 2003년 1월 1일부터 2004년 12월 31일까지 한림대학교 병원에 결핵으로 확진되어 치료한 신환에서 사망한 환자 27명과 호전되어 퇴원한 환자 중 나이와 성별을 짝지은 54명을 대조군으로 비교분석하였다. 결 과: 사망군의 평균 나이는 $60{\pm}16$세이며, 남자가 70%였다. 대조군에 비해 사망군에서 혈색소, 알부민과 콜레스테롤이 유의하게 낮았으며(p <0.05), 혈액요소질소, AST, C-reactive protein는 유의하게 높았다(p <0.05). 사망군에서 대조군에 비해 결핵의 기왕력은 차이가 없었으며, 방사선학적 중증도, 동반질환, 내원시 호흡곤란, 응급실을 통한 입원과 초기 중환자실 치료가 유의하게 높았다(p <0.05). 다중회귀분석을 통해 알부민과 초기 중환자실 치료가 독립적으로 사망에 영향을 미치는 인자로 밝혀졌다(p <0.05). 결 론: 심한 영양결핍을 동반한 중증 결핵 환자는 사망에 고위험군으로 결핵 환자의 조기 발견 및 치료에 개선이 필요하며, 효율적인 공공 보건 교육, 검진정책과 환자관리가 중요할 것으로 사료된다.

Keywords

References

  1. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country: WHO Global Surveillance and Monitoring Project. JAMA 1999:282:677-86 https://doi.org/10.1001/jama.282.7.677
  2. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006:367:1747-57 https://doi.org/10.1016/S0140-6736(06)68770-9
  3. Hansel NN, Wu AW, Chang B, Diette GB. Quality of life in tuberculosis: patient and provider perspectives. Qual Life Res 2004:13:639-52 https://doi.org/10.1023/B:QURE.0000021317.12945.f0
  4. Rao VK, Iademarco EP, Fraser VJ, Kollef MH. The impact of comorbidity on mortality following in-hopital diagnosis of tuberculosis. Chest 1998:114:1244-52 https://doi.org/10.1378/chest.114.5.1244
  5. Singleton L, Turner M, Haskal R, Etkind S, Tricarico M, Nardell E. Long-term hospitalization for tuberculosis control: experience with a medical-psychosocial inpatient unit. JAMA 1997:278:838-42 https://doi.org/10.1001/jama.278.10.838
  6. Greenaway C, Menzies D, Fanning A, Grewal R, Yuan L, FitzGerald JM. Delay in diagnosis among hospitalized patietns with active tuberculosis: predictors and outcomes. Am J Respir Crit Care Med 2002: 165:927-33 https://doi.org/10.1164/ajrccm.165.7.2107040
  7. Stoneburner R, Laroche E, Prevots R, Singh T, Blum S, Terry P, et al. Survival in a cohort of human immunodeficiency virus-infected tuberculosis patients in New York City. Arch Intern Med 1992:152:2033-7 https://doi.org/10.1001/archinte.152.10.2033
  8. Goble M, Iseman MD, Madsen LA, Madsen LA, Waite D, Ackerson L, et al. Treatment of 171 patients with pulmonary tuberculosis resistant to isonizid and rifampin. N Engl J Med 1993:328:527-32 https://doi.org/10.1056/NEJM199302253280802
  9. Park MM, Davis AL, Schluger NW, Cohen H, Rom WN. Outcome of MDR-TB patients, 1983-1993:prolonged survival with appropriate therapy. Am J Respir Crit Care Med 1996:153:317-24 https://doi.org/10.1164/ajrccm.153.1.8542137
  10. Pablos-Mendez A, Sterling TR, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA 1996:276:1223-8 https://doi.org/10.1001/jama.276.15.1223
  11. Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis 2005:9:777-83
  12. Fang HC, Lee PT, Chen CL, Wu MJ, Chou KJ, Chung HM. Tuberculosis in patients with end-stage renal disease. Int J Tuberc Lung Dis 2004:8:92-7
  13. Mehta JB, Fields CL, Byrd RP Jr, Roy TM. Nutritional status and mortality in respiratory failure caused by tuberculosis. Tenn Med 1996:89:369-71
  14. Lee PL, Jerng JS, Chang YL, Chen CF, Hsueh PR, Yu CJ, et al. Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation. Eur Respir J 2003:22:141-7 https://doi.org/10.1183/09031936.03.00038703
  15. Penner C, Roberts D, Kunimoto D, Manfreda J, Long R. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med 1995;151:867-72 https://doi.org/10.1164/ajrccm/151.3_Pt_1.867
  16. Frame RN, Johnson MC, Eichenhorn MS, Bower GC, Popovich J Jr. Active tuberculosis in the medical intensive care units: a 15-year retrospective analysis. Crit Care Med 1987:15:1012-4 https://doi.org/10.1097/00003246-198711000-00005
  17. Pompei P, Charlson ME, Ales K, MacKenzie CR, Norton M. Relating patient characteristics at the time admission to outcome of hospitalization. J Clin Epidemiol 1991:44:1063-9 https://doi.org/10.1016/0895-4356(91)90008-W
  18. Greenfield S, Aronow HU, Elashoff RM, Watanabe D. Flaws in mortality data: the hazards of ignoring comorbid disease. JAMA 1988:260:2253-5 https://doi.org/10.1001/jama.260.15.2253
  19. Hansel NN, Merriman B, Haponik EF, Diette GB. Hospitalization for tuberculosis in the United States in 2000: predictors of in-hospital mortality. Chest 2004:126:1079-86 https://doi.org/10.1378/chest.126.4.1079