결핵으로 입원한 환자의 병원내 사망과 관련된 인자
Predictors on In-hospital Mortality Foll
장승훈 (한림대학교)
김동규 (한림대학교)
이재영 (한림대학교)
모은경 (한림대학교)
이명구 (한림대학교)
정기석 (한림대학교)
김창환 (한림의대)
김성은 (한림의대)
박용범 (한림대학교)
김철홍 (한림의대)
엄광석 (한림의대)
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초록
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 ± 16세이며, 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).
- keywords
- Mycobacterium tuberculosis, Mortality, Tuberculosis., Mycobacterium tuberculosis, Mortality, Tuberculosis.
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 ± 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. (Tuberc Respir Dis 2006; 61: 233-238)
- keywords
- Mycobacterium tuberculosis, Mortality, Tuberculosis., Mycobacterium tuberculosis, Mortality, Tuberculosis.
참고문헌
(1999) Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country: WHO Global Surveillance and Monitoring Project,
(2006) Global and regional burden of disease and risk factors systematic analysis of population health data,
(2004) Quality of life in tuberculosis:patient and provider perspectives,
(1998) The impact of comorbidity on mortality following in-hopital diagnosis of tuberculosis,
(1997) Long-term hospitalization for tuberculosis control:experience with a medical-psychosocial inpatient unit,
(2002) Delay in diagnosis among hospitalized patietns with active tuberculosis:predictors and outcomes,
(1992) Survival in a cohort of human immunodeficiency virus-infected tuberculosis patients in New York City,
(1993) Treatment of 171 patients with pulmonary tuberculosis resistant to isonizid and rifampin,
(1996) Outcome of MDR-TB patients 1983-1993: prolonged survival with appropriate therapy,
(1996) The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis,
(2005) Factors changing the manifestation of pulmonary tuberculosis,
(2004) Tuberculosis in patients with end-stage renal disease,
(1996) Nutritional status and mortality in respiratory failure caused by tuberculosis,
(2003) Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation,
(1995) Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation,
(1987) Active tuberculosis in the medical intensive care units:a 15-year retrospective analysis,
(1991) Relating patient characteristics at the time admission to outcome of hospitalization,
(1988) Flaws in mortality data:the hazards of ignoring comorbid disease,
(2004) Hospitalization for tuberculosis in the United States in 2000:predictors of in-hospital mortality,
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