Effect of pulmonary tuberculosis on clinical outcomes of long-term dialysis patients: Pre- and post-DOTS implementation in Taiwan

研究成果: 雜誌貢獻文章

摘要

Background and objective: The link between tuberculosis (TB) and dialysis is known; however, the impact of TB on the clinical outcomes remains to be elucidated. This study aims to determine the clinical consequences of pulmonary TB among patients under long-term dialysis. Methods: A retrospective propensity-scores matched (1:4) cohort study was conducted by retrieving patient data for pulmonary TB after long-term dialysis commencement from the Taiwan National Health Insurance Research Database between 1999 and 2013. Patients with TB (n=1993) or without TB (n=7972) were compared for 3-year morbidity and mortality. The effect of Directly Observed Treatment, Short-Course (DOTS) implementation was also evaluated. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs). Results: TB patients had a significantly higher risk of mortality than non-TB patients even after multivariate adjustment (HR: 1.48; 95% CI: 1.36-1.60; P<0.001). DOTS implementation reduced the risk of some morbidities such as pneumonia, hospitalization and intensive care unit stay >7days, but not inotropic agent usage, ventilator therapy >21days and mortality in TB patients. In pulmonary TB patients with treatment duration ≥180days, DOTS implementation also lowered the risk of TB relapse (HR: 0.33; 95% CI: 0.19-0.55; P<0.001), irrespective of treatment duration (180-224 or ≥225days). Conclusion: Pulmonary TB increases the risk of morbidity and mortality in dialysis patients; DOTS implementation reduces some morbidities and TB relapse. Continuing DOTS implementation should be encouraged to improve clinical outcomes in dialysis patients.
原文英語
期刊Respirology
DOIs
出版狀態接受/付印 - 2017

指紋

Taiwan
Pulmonary Tuberculosis
Dialysis
Tuberculosis
Therapeutics
Mortality
Morbidity
Recurrence
Propensity Score
National Health Programs
Mechanical Ventilators
Proportional Hazards Models
Cohort Studies
Databases
Research

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

引用此文

@article{3967b8ab7b524e3a82c10567308a954f,
title = "Effect of pulmonary tuberculosis on clinical outcomes of long-term dialysis patients: Pre- and post-DOTS implementation in Taiwan",
abstract = "Background and objective: The link between tuberculosis (TB) and dialysis is known; however, the impact of TB on the clinical outcomes remains to be elucidated. This study aims to determine the clinical consequences of pulmonary TB among patients under long-term dialysis. Methods: A retrospective propensity-scores matched (1:4) cohort study was conducted by retrieving patient data for pulmonary TB after long-term dialysis commencement from the Taiwan National Health Insurance Research Database between 1999 and 2013. Patients with TB (n=1993) or without TB (n=7972) were compared for 3-year morbidity and mortality. The effect of Directly Observed Treatment, Short-Course (DOTS) implementation was also evaluated. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs). Results: TB patients had a significantly higher risk of mortality than non-TB patients even after multivariate adjustment (HR: 1.48; 95{\%} CI: 1.36-1.60; P<0.001). DOTS implementation reduced the risk of some morbidities such as pneumonia, hospitalization and intensive care unit stay >7days, but not inotropic agent usage, ventilator therapy >21days and mortality in TB patients. In pulmonary TB patients with treatment duration ≥180days, DOTS implementation also lowered the risk of TB relapse (HR: 0.33; 95{\%} CI: 0.19-0.55; P<0.001), irrespective of treatment duration (180-224 or ≥225days). Conclusion: Pulmonary TB increases the risk of morbidity and mortality in dialysis patients; DOTS implementation reduces some morbidities and TB relapse. Continuing DOTS implementation should be encouraged to improve clinical outcomes in dialysis patients.",
keywords = "Dialysis, Directly Observed Treatment, Short-Course, Mortality, Relapse, Tuberculosis",
author = "Bai, {Kuan Jen} and Huang, {Kuan Chih} and Lee, {Chih Hsin} and Tang, {Chao Hsiun} and Yu, {Ming Chih} and Sue, {Yuh Mou}",
year = "2017",
doi = "10.1111/resp.12983",
language = "English",
journal = "Respirology",
issn = "1323-7799",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Effect of pulmonary tuberculosis on clinical outcomes of long-term dialysis patients

T2 - Pre- and post-DOTS implementation in Taiwan

AU - Bai, Kuan Jen

AU - Huang, Kuan Chih

AU - Lee, Chih Hsin

AU - Tang, Chao Hsiun

AU - Yu, Ming Chih

AU - Sue, Yuh Mou

PY - 2017

Y1 - 2017

N2 - Background and objective: The link between tuberculosis (TB) and dialysis is known; however, the impact of TB on the clinical outcomes remains to be elucidated. This study aims to determine the clinical consequences of pulmonary TB among patients under long-term dialysis. Methods: A retrospective propensity-scores matched (1:4) cohort study was conducted by retrieving patient data for pulmonary TB after long-term dialysis commencement from the Taiwan National Health Insurance Research Database between 1999 and 2013. Patients with TB (n=1993) or without TB (n=7972) were compared for 3-year morbidity and mortality. The effect of Directly Observed Treatment, Short-Course (DOTS) implementation was also evaluated. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs). Results: TB patients had a significantly higher risk of mortality than non-TB patients even after multivariate adjustment (HR: 1.48; 95% CI: 1.36-1.60; P<0.001). DOTS implementation reduced the risk of some morbidities such as pneumonia, hospitalization and intensive care unit stay >7days, but not inotropic agent usage, ventilator therapy >21days and mortality in TB patients. In pulmonary TB patients with treatment duration ≥180days, DOTS implementation also lowered the risk of TB relapse (HR: 0.33; 95% CI: 0.19-0.55; P<0.001), irrespective of treatment duration (180-224 or ≥225days). Conclusion: Pulmonary TB increases the risk of morbidity and mortality in dialysis patients; DOTS implementation reduces some morbidities and TB relapse. Continuing DOTS implementation should be encouraged to improve clinical outcomes in dialysis patients.

AB - Background and objective: The link between tuberculosis (TB) and dialysis is known; however, the impact of TB on the clinical outcomes remains to be elucidated. This study aims to determine the clinical consequences of pulmonary TB among patients under long-term dialysis. Methods: A retrospective propensity-scores matched (1:4) cohort study was conducted by retrieving patient data for pulmonary TB after long-term dialysis commencement from the Taiwan National Health Insurance Research Database between 1999 and 2013. Patients with TB (n=1993) or without TB (n=7972) were compared for 3-year morbidity and mortality. The effect of Directly Observed Treatment, Short-Course (DOTS) implementation was also evaluated. Cox proportional hazards models were used to determine adjusted hazard ratios (HRs). Results: TB patients had a significantly higher risk of mortality than non-TB patients even after multivariate adjustment (HR: 1.48; 95% CI: 1.36-1.60; P<0.001). DOTS implementation reduced the risk of some morbidities such as pneumonia, hospitalization and intensive care unit stay >7days, but not inotropic agent usage, ventilator therapy >21days and mortality in TB patients. In pulmonary TB patients with treatment duration ≥180days, DOTS implementation also lowered the risk of TB relapse (HR: 0.33; 95% CI: 0.19-0.55; P<0.001), irrespective of treatment duration (180-224 or ≥225days). Conclusion: Pulmonary TB increases the risk of morbidity and mortality in dialysis patients; DOTS implementation reduces some morbidities and TB relapse. Continuing DOTS implementation should be encouraged to improve clinical outcomes in dialysis patients.

KW - Dialysis

KW - Directly Observed Treatment, Short-Course

KW - Mortality

KW - Relapse

KW - Tuberculosis

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U2 - 10.1111/resp.12983

DO - 10.1111/resp.12983

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JF - Respirology

SN - 1323-7799

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