Analysis of influencing factors of death in TB patients complicated with AIDS during anti-tuberculosis treatment in Yunnan, 2011-2019

doi:10.3969/j.issn.1000-6621.2021.02.005

Abstract

Abstract:

Objective To investigate the influencing factors for deaths of tuberculosis (TB) patients complicated with acquired immune deficiency syndrome(AIDS) during anti-tuberculosis treatment in Yunnan province from 2011 to 2019, so as to provide a reference for the prevention and treatment of TB patients complicated with AIDS. Methods Treatment information about 3329 TB patients complicated with AIDS receiving anti-tuberculosis treatment in Yunnan province from January 2011 to December 2019 was collected via the “Tuberculosis Management Information System”. The demographic characteristics, clinical characteristics, and antiviral treatment of 246 patients (7.39%, 246/3329) who died during anti-tuberculosis treatment were described. Kaplan-Meier method, Log-rank test and Cox proportional hazard regression model were used to analyze the influencing factors of death. Results Among the 246 patients, 98 (39.84%,98/246) died during intensive phase of anti-tuberculosis treatment. The majority of death cases were males (81.71%,201/246);the median age (M(Q₁,Q₃)) of them was 40 (33, 48) years. Cox regression model showed that patients over 60 years old (aHR=2.00, 95%CI=1.27-3.15), with a CD4⁺T lymphocyte level of 50-<400 cells/μl (aHR=3.23, 95%CI=1.63-6.42), CD4⁺T lymphocyte level <50 cells/μl (aHR=8.96, 95%CI=4.37-18.38), only taking anti-tuberculosis treatment (aHR=1.74, 95%CI=1.13-2.67), patients treated in designated TB hospitals (aHR=1.58, 95%CI=1.19-2.10) had a higher risk of death. Conclusion TB patients complicated with AIDS had a relatively high risk of death during anti-tuberculosis treatment. We should especially focus on patients in the intensive phase of anti-tuberculosis treatment, and those over 60 years old. In addition, tuberculosis prevention and treatment training should be strengthened for doctors in TB designated hospitals to improve diagnostic and therapeutic capabilities, so as to reduce the fatality rate of those patients.

Key words: Tuberculosis, Acquired immune deficiency syndrome, Death, Factor analysis, Yunnan province

YE Jin-xin, XU Lin, CHEN Jin-ou, QIU Yu-bing, LYU Tong. Analysis of influencing factors of death in TB patients complicated with AIDS during anti-tuberculosis treatment in Yunnan, 2011-2019[J]. Chinese Journal of Antituberculosis, 2021, 43(2): 126-131. doi: 10.3969/j.issn.1000-6621.2021.02.005

Figures/Tables 3

变量	β值	s $x ˉ$ 值	χ²值	P值	aHR(95%CI)值
年龄组(岁)
0~14	0.33	0.72	0.21	0.647	1.39(0.34~5.75)
15~29	0.10	0.23	0.18	0.675	1.10(0.71~1.71)
30~44	0.04	0.17	0.05	0.831	1.04(0.75~1.44)
45~59
≥60	0.69	0.23	8.90	0.003	2.00(1.27~3.15)
CD4⁺T 淋巴细胞水平(个/μl)
≥400
50~<400	1.17	0.35	11.22	0.001	3.23(1.63~6.42)
<50	2.19	0.37	35.80	<0.01	8.96(4.37~18.38)
未知	1.39	0.35	15.48	<0.01	4.00(2.00~7.93)
特殊人群(羁押)
是
否	1.24	0.51	5.93	0.015	3.44(1.27~9.31)
抗病毒和抗结核治疗情况
抗病毒在抗结核前或同时进行
抗病毒在抗结核之后	0.13	0.25	0.25	0.620	1.13(0.69~1.87)
仅抗结核	0.55	0.22	6.38	0.012	1.74(1.13~2.67)
抗病毒情况未知	0.50	0.17	9.00	0.003	1.64(1.19~2.27)
患者治疗地点
疾病预防控制中心结核门诊
结核病定点医院	0.46	0.14	10.06	0.002	1.58(1.19~2.10)

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临床特征	患者[例(构成比,%)]	死亡[例(病亡率,%)]	χ²值	P值
性别			0.43	0.511
男	2670(80.20)	201(7.53)
女	659(19.80)	45(6.83)
年龄组(岁)			11.98	0.018
0~14	20(0.60)	2(10.00)
15~29	456(13.70)	34(7.46)
30~44	1885(56.62)	130(6.90)
45~59	732(21.99)	50(6.83)
≥60	236(7.09)	30(12.71)
民族			0.01	0.938
汉族	2058(61.82)	152(7.39)
少数民族	1271(38.18)	94(7.40)
职业			3.21	0.073
农民	2431(73.02)	192(7.90)
非农民	898(27.98)	54(6.01)
临床特征	患者[例(构成比,%)]	死亡[例(病亡率,%)]	χ²值	P值
特殊人群(羁押)			7.62	0.006
否	3140(94.32)	242(7.71)
是	189(5.68)	4(2.12)
就诊延迟时间(d)			0.29	0.589
≤33	1675(50.32)	127(7.58)
>33	1654(49.68)	119(7.19)
痰涂片			0.82	0.664
涂阴	2367(71.10)	169(7.14)
涂阳	890(26.74)	69(7.75)
未知	72(2.16)	8(11.11)
治疗分类			0.20	0.652
初治	2891(86.84)	212(7.33)
复治	438(13.16)	34(7.76)
CD4⁺ T 淋巴细胞水平(个/μl)			60.17	<0.01
≥400	453(13.61)	9(1.99)
50~<400	1395(41.90)	90(6.45)
<50	273(8.20)	46(16.85)
未知	1208(36.29)	101(8.36)
抗病毒和抗结核治疗情况			10.77	0.013
仅抗结核	557(16.73)	43(7.72)
抗病毒情况未知	1308(39.29)	116(8.87)
抗病毒在抗结核前或同时进行	1166(35.03)	66(5.66)
抗病毒在抗结核之后	298(8.95)	21(7.05)
患者治疗机构			5.48	0.019
疾病预防控制中心结核门诊	2191(65.82)	144(6.57)
结核病定点医院	1138(34.18)	102(8.96)

变量名称	变量赋值
年龄	0~14岁=1,15~29岁=2,30~44=3,45~59岁^a=0,≥60岁=4
CD4⁺T 淋巴细胞水平	≥400个/μl^a=0, 50~<400个/μl=1,<50个/μl=2,未知=3
特殊人群(羁押)	是^a=0,否=1
抗病毒和抗结核治疗	抗病毒在抗结核前或同时进行^a=0,仅抗结核=1,抗病毒情况未知=2,抗病毒在抗结核之后=3
患者治疗机构	疾病预防控制中心结核门诊^a=0,结核病定点医院=1