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Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study

BACKGROUND: We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes. METHODS: Medical records of all cases in 1995 – 1996 were ab...

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Autores principales: Vasankari, Tuula, Holmström, Pekka, Ollgren, Jukka, Liippo, Kari, Kokki, Maarit, Ruutu, Petri
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099439/
https://www.ncbi.nlm.nih.gov/pubmed/17935630
http://dx.doi.org/10.1186/1471-2458-7-291
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author Vasankari, Tuula
Holmström, Pekka
Ollgren, Jukka
Liippo, Kari
Kokki, Maarit
Ruutu, Petri
author_facet Vasankari, Tuula
Holmström, Pekka
Ollgren, Jukka
Liippo, Kari
Kokki, Maarit
Ruutu, Petri
author_sort Vasankari, Tuula
collection PubMed
description BACKGROUND: We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes. METHODS: Medical records of all cases in 1995 – 1996 were abstracted to assess outcome of treatment. Outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis. RESULTS: Among 629 cases a favourable outcome was achieved in 441 (70.1%), 17.2% (108) died and other unfavourable outcome took place in 12.7% (80). Significant independent risk factors for death were male sex, high age, non-HIV -related immunosuppression and any other than a pulmonary specialty being responsible for stopping treatment. History of previous tuberculosis was inversely associated with the risk of death. For other unfavourable treatment outcomes, significant risk factors were pause(s) in treatment, treatment with INH+RIF+EMB/SM, and internal medicine specialty being responsible at the end of the treatment. CONCLUSION: We observed a significant association with unfavourable outcome for the specialty responsible for treatment being other than pulmonary, but not for the volume of cases, which has implications for system arrangements. Poor outcomes associated with immunosuppression and advanced age, with frequent comorbidity, stress a low threshold of suspicion, availability of rapid diagnostics, and early empiric treatment as probable approaches in attempting to improve treatment outcomes in countries with very low incidence of TB.
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spelling pubmed-20994392007-11-30 Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study Vasankari, Tuula Holmström, Pekka Ollgren, Jukka Liippo, Kari Kokki, Maarit Ruutu, Petri BMC Public Health Research Article BACKGROUND: We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes. METHODS: Medical records of all cases in 1995 – 1996 were abstracted to assess outcome of treatment. Outcome was divided into three groups: favourable, death and other unfavourable. Predictors of unfavourable outcome were assessed in univariate and multivariate analysis. RESULTS: Among 629 cases a favourable outcome was achieved in 441 (70.1%), 17.2% (108) died and other unfavourable outcome took place in 12.7% (80). Significant independent risk factors for death were male sex, high age, non-HIV -related immunosuppression and any other than a pulmonary specialty being responsible for stopping treatment. History of previous tuberculosis was inversely associated with the risk of death. For other unfavourable treatment outcomes, significant risk factors were pause(s) in treatment, treatment with INH+RIF+EMB/SM, and internal medicine specialty being responsible at the end of the treatment. CONCLUSION: We observed a significant association with unfavourable outcome for the specialty responsible for treatment being other than pulmonary, but not for the volume of cases, which has implications for system arrangements. Poor outcomes associated with immunosuppression and advanced age, with frequent comorbidity, stress a low threshold of suspicion, availability of rapid diagnostics, and early empiric treatment as probable approaches in attempting to improve treatment outcomes in countries with very low incidence of TB. BioMed Central 2007-10-14 /pmc/articles/PMC2099439/ /pubmed/17935630 http://dx.doi.org/10.1186/1471-2458-7-291 Text en Copyright © 2007 Vasankari et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Vasankari, Tuula
Holmström, Pekka
Ollgren, Jukka
Liippo, Kari
Kokki, Maarit
Ruutu, Petri
Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study
title Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study
title_full Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study
title_fullStr Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study
title_full_unstemmed Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study
title_short Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study
title_sort risk factors for poor tuberculosis treatment outcome in finland: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099439/
https://www.ncbi.nlm.nih.gov/pubmed/17935630
http://dx.doi.org/10.1186/1471-2458-7-291
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