[The influence of comorbidities on treatment outcomes in patients with tuberculosis].

IF 0.3 4区医学 Q3 MEDICINE, GENERAL & INTERNAL Terapevticheskii Arkhiv Pub Date : 2024-09-14 DOI:10.26442/00403660.2024.08.202812

D A Ivanova, E M Belilovskiy, E M Bogorodskaya, M N Reshetnikov, D V Plotkin, V B Avdentova

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引用次数: 0

Abstract

Aim: To study the association of comorbidities and treatment outcomes in tuberculosis (TB) patients.

Materials and methods: A retrospective study includes all TB patients aged 18 years and older registered for treatment in Moscow in period 2021 the end of the 3rd quarter of 2022 using data of regional epidemiological TB monitoring system, a total of 3039 patients. The frequency and spectrum of comorbidities, its impact on the risk of adverse treatment outcome (ATO) and mortality using univariate and regression analysis were assessed.

Results: Comorbidities were identified in 1528 (50.3%) patients (95% confidence interval - CI 48.5-52.1); HIV infection (18.0%), chronic nonspecific lung disease (9.6%) and cardiovascular disease (8.2%) were predominant. The presence of comorbid pathology increased the odds of uneffective treatment (odds ratio - OR 2.56, 95% CI 2.22-3.03) and death (OR 2.45, 95% СI 1.67-3.59). Independent risk factors for ATO were HIV infection (OR 4.10, 95% CI 3.36-5.10), substance use (OR 2.57, 95% CI 1.70-3.66), chronic nonspecific lung disease (OR 1.39, 95% CI 1.04-1.88), diabetes mellitus (OR 1.69, 95% CI 1.15-2.48), liver pathology (OR 2.10, 95% CI 1.46-3.03), mental illness (OR 2.01, 95% CI 1.32-3.06). The death rate was 13.4%; the most significant predictors of mortality were HIV infection (OR 3.89, 95% CI 2.42-6.22) and liver disease (OR 1.90, 95% CI 1.27-2.82). A comorbidome model was constructed to assess the importance of different comorbidities for patient prognosis.

Conclusion: The presence of comorbidity (predominantly HIV infection and liver disease) is a significant risk factor for ATO and mortality in TB patients, which should be taken into account when organizing and providing TB care to comorbid patients.

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[合并症对肺结核患者治疗效果的影响]。

目的：研究肺结核（TB）患者的合并症与治疗效果之间的关系：回顾性研究使用地区结核病流行病学监测系统的数据，包括 2021 年至 2022 年第三季度末在莫斯科登记治疗的所有 18 岁及以上结核病患者，共计 3039 人。采用单变量和回归分析法评估了合并症的频率和范围及其对不良治疗结果（ATO）和死亡率风险的影响：结果：1528 名患者（50.3%）（95% 置信区间 - CI 48.5-52.1）患有合并症；其中以艾滋病病毒感染（18.0%）、慢性非特异性肺部疾病（9.6%）和心血管疾病（8.2%）为主。合并症的存在增加了治疗无效（几率比-OR 2.56，95% CI 2.22-3.03）和死亡（OR 2.45，95% СI 1.67-3.59）的几率。ATO的独立风险因素为HIV感染（OR 4.10，95% CI 3.36-5.10）、药物使用（OR 2.57，95% CI 1.70-3.66）、慢性非特异性肺病（OR 1.39，95% CI 1.04-1.88）、糖尿病（OR 1.69，95% CI 1.15-2.48）、肝脏病变（OR 2.10，95% CI 1.46-3.03）、精神疾病（OR 2.01，95% CI 1.32-3.06）。死亡率为 13.4%；死亡率的最重要预测因素是艾滋病病毒感染（OR 3.89，95% CI 2.42-6.22）和肝脏疾病（OR 1.90，95% CI 1.27-2.82）。我们建立了一个合并症组模型，以评估不同合并症对患者预后的重要性：结论：合并症（主要是艾滋病病毒感染和肝脏疾病）是结核病患者发生 ATO 和死亡的重要风险因素，在为合并症患者组织和提供结核病护理时应考虑到这一点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Terapevticheskii Arkhiv 医学-医学：内科

CiteScore

1.40

自引率

33.30%

发文量

171

审稿时长

3-8 weeks

期刊介绍： Терапевтический архив The journal was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal. Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases. The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists. The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal. The journal is indexed in RSCI (Russian Science Citation Index), PubMed/Medline, Index Medicus, Scopus/EMBASE, Web of Science Core Collection (Science Citation Index Expanded), Web of Science (Russian Science Citation Index - RSCI, Current Contents Connect, BIOSIS Previews), Google Scholar, Ulrich''s Periodicals Directory. The journal is included in the list of periodicals recommended by the Higher Attestation Committee for publishing the papers containing the basic materials of doctoral and candidate dissertations. By the decision of the Presidium of the Russian Academy of Medical Sciences, the “Therapevticheskiy Arkhiv” was awarded the Botkin medal. It was admitted to the European Association of Sciences Editors (EASE). The journal was honored with the Golden Press Fund decoration at the 13th International Press Professional Exhibition.