Site of tuberculosis disease by age.

BackgroundThe high case-fatality rates among children with tuberculosis (TB) are reportedly driven by in-hospital mortality and severe forms of TB. Therefore, there is need to better understand the predictors of mortality among children hospitalised with TB. We examined the patient clinical profiles, length of hospital stay from date of admission to date of final admission outcome, and predictors of mortality among children hospitalised with TB at two tertiary hospitals in Uganda.MethodsWe conducted a case-series study of children below 15 years of age hospitalised with TB, from January 1st, 2016, to December 31st, 2021. Convenience sampling was done to select TB cases from paper-based medical records at Mulago National Referral Hospital (MNRH) in urban Kampala, and Fort Portal Regional Referral Hospital (FRRH) in rural Fort Portal. We fitted linear and logistic regression models with length of stay and in-hospital mortality as key outcomes.ResultsOut of the 201 children hospitalised with TB, 50 were at FRRH, and 151 at MNRH. The male to female ratio was 1.5 with median age of 2.6 years (Interquartile range-IQR 1–6). There was a high prevalence of HIV (67/171, 39%), severe malnutrition reported as weight-for-age Z-score ConclusionsIn-hospital mortality was high, and significantly driven almost four times higher by TB meningitis, with longer hospital stay among children in urban hospitals. The high in-hospital mortality and long hospital stay may be reduced by timely TB diagnosis and treatment initiation among children.

【背景】据报道，儿童结核病（tuberculosis, TB）患者的高病死率主要由住院病死率与重症结核导致。因此，亟需深入探析住院治疗的结核患儿的死亡预测因素。本研究针对乌干达两家三级医院收治的结核患儿展开分析，考察其临床特征、从入院至最终住院结局的住院时长，以及死亡预测因素。
【方法】本研究于2016年1月1日至2021年12月31日期间，针对15岁以下住院结核患儿开展病例系列研究。研究采用便利抽样法，从坎帕拉市区的穆拉戈国家转诊医院（Mulago National Referral Hospital, MNRH）以及农村福特波特尔的福特波特尔区域转诊医院（Fort Portal Regional Referral Hospital, FRRH）的纸质病历中筛选结核病例。本研究以住院时长与住院病死率为主要结局指标，构建线性回归与逻辑回归模型。
【结果】在201例住院结核患儿中，50例来自FRRH，151例来自MNRH。男女比例为1.5:1，中位年龄为2.6岁（四分位间距interquartile range, IQR：1~6岁）。HIV感染率较高（67/171，39%），且存在以年龄别体重Z评分判定的重度营养不良情况。
【结论】本研究中住院病死率较高，结核性脑膜炎导致的死亡风险显著升高近4倍，且城市医院收治患儿的住院时长更长。及时开展儿童结核的诊断与治疗，或可降低较高的住院病死率与延长的住院时长。