| Summary: | 碩士 === 國立臺灣大學 === 預防醫學研究所 === 92 === Objectives To identify the relationships of clinical characteristics, compliance to treatment, and type of diagnosis with the mortality in patients with tuberculosis (TB).
Method A retrospective cohort study was conducted at a regional hospital with 500 beds in northernTaiwan.
Subjects and methods All patients with tuberculosis notified to Center for Disease Control in Taiwan from 1 January 1998 to 31 December 2001 in this hospital were included in this study. Information was collected from their medical records at the commencement of treatment and at 12 months after treatment. The data collected for each patient included demographic characteristics, history of treatment, site of disease, case category, treatment regimen, bacteriological status, radiological category, and treatment outcome results.
Results There were 477 patients meet the inclusion criteria for analysis. Half of the patients were aged 60 years or older, and 66% were male. Pulmonary disease alone accounted for 65.2% of the patients, extrapulmonary lesions only was seen in 31.0%, while both pulmonary and extrapulmonary disease consisted of 3.8%. Newly diagnosed cases comprised 87.6% of the patients, and 58.9% had other concomitant illnesses. There were excess risk of disease among patients who were male, who had diabetes mellitus, pneumoconiosis or chronic obstructive pulmonary disease, and cerebral vascular attack. Only 0.2% of the patients were co-infected with human immunodeficiency virus infection. Among 477 patients evaluated, moderate or severe radiological findings were found in 71.2% of the patients, cavitation in 13.2%, pleural effusion in 15.7%, military lesion in 6.3%, mild infiltration in 10.7%, and no abnormal finding in 4.6%. Sputum acid-fast positive rate was 40.3% and TB culture positive rate was 62.8%. The overall completion rate of treatment at 12 months was 74%. Patient with adverse reaction to antitubewrculosis treatment was 25.6%. Of 477 patients, 106 (22%) died. 7.8% of patients with antituberculosis complete treatment, 49.2% of patients with defaulted treatment, and 82.1% of patients with no treatment died. 15% of all patients died from tuberculosis.
Conclusions Male, patients with co-morbidity, no clinical symptoms or antituberculosis adverse reaction were key factors influencing treatment compliance. Cumulative survival analysis revealed that the predominant factor of TB-related mortality hazard ratio was poor compliance with treatment. Active screening of clearly identified risk groups may be appropriate and requires more efforts to monitor defaulted and untreated patients.
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