Data_Sheet_1_Deaths from tuberculosis: differences between tuberculosis-related and non-tuberculosis-related deaths.docx

ObjectiveTuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide. The first step in developing strategies to reduce TB mortality is to identify the direct causes of death in patients with TB and the risk factors for each cause.
MethodsData on patients with TB systemically collected from the National Surveillance System of South Korea from January 2019 to December 2020 were included in this study. We analyzed the clinical characteristics associated with TB and non-TB-related deaths, including TB-related symptoms, comorbidities, and radiographic and microbiological findings.
ResultsOf the total of 12,340 patients with TB, 61% were males with a mean age of 61.3 years. During the follow-up period, the overall mortality rate was 10.6%, with TB-related deaths accounting for 21.3% of all TB deaths. The median survival time in the TB-related death group was 22 days. TB-related death was associated with older age, lower body mass index (BMI), dyspnea, fever, general weakness, bilateral radiographic patterns, and acid-fast bacilli (AFB)-positive smears. Non-TB-related deaths were associated with older age, male sex, lower BMI, comorbidities of heart, liver, kidney, and central nervous system (CNS) diseases, CNS TB involvement, the presence of dyspnea, general weakness, and bilateral radiographic patterns.
ConclusionPatients with high-risk TB must be identified through cause-specific mortality analysis, and the mortality rate must be reduced through intensive monitoring of patients with a high TB burden and comorbidities.

研究目标：结核病（Tuberculosis, TB）是全球范围内引发健康损害的主要病因之一，同时也是主要致死性疾病之一。制定降低结核病死亡率防控策略的首要环节，是明确结核病患者的直接死亡诱因，以及各类诱因对应的风险因素。
研究方法：本研究纳入2019年1月至2020年12月期间，从韩国国家结核病监测系统中系统性采集的结核病患者临床数据。本研究分析了与结核病相关及非结核病相关死亡相关的临床特征，涵盖结核病相关症状、合并症、影像学及微生物学检查结果。
研究结果：在总计12340名结核病患者中，61%为男性，平均年龄为61.3岁。随访期间总体死亡率为10.6%，其中结核病相关死亡占所有结核病患者死亡病例的21.3%。结核病相关死亡组患者的中位生存时间为22天。结核病相关死亡与高龄、较低的体质量指数（Body Mass Index, BMI）、呼吸困难、发热、全身乏力、双侧影像学病灶表现以及抗酸杆菌（Acid-Fast Bacilli, AFB）涂片阳性显著相关。非结核病相关死亡则与高龄、男性性别、较低的BMI、合并心肝肾及中枢神经系统（Central Nervous System, CNS）疾病、中枢神经系统结核累及、存在呼吸困难、全身乏力以及双侧影像学病灶表现显著相关。
研究结论：需通过死因特异性死亡率分析，识别高风险结核病患者，并通过对结核负荷较高且伴有合并症的患者实施强化监测，以降低结核病死亡率。