Influencing factors of the adverse outcome of pulmonary tuberculosis among adolescents in Hangzhou City between 2005 and 2020: a school-based retrospective cohort study / 中华预防医学杂志

Objective: To explore the influencing factors of the adverse outcome of pulmonary tuberculosis (PTB) among adolescents in Hangzhou City between 2005 and 2020. Methods: A retrospective cohort study was used to collect the information of adolescent PTB patients with the onset of PTB occurring from January 1, 2005 to December 31 in 12 designated tuberculosis hospitals in Hangzhou, mainly including demographic, epidemiological, clinical manifestations, bacteriological characteristics and other data, through the China Management Information System for Infectious Disease Surveillance and Reporting and the follow-up survey. All patients were followed up and the end time was December 31, 2021. Multivariate Cox regression model was used to analyze the factors affecting the adverse outcome of these patients. Results: The mean age of 4 921 adolescent PTB patients was (18.9±3.6) years old, and the number of male and female patients were 3 074 and 1 847 respectively. The adverse outcome accounted for 14.7% (725) of all patients. Multivariate Cox regression model showed that eight risk factors, including management model from patients themselves or family members (HR=5.87, 95%CI: 4.55-7.64), molecular biology examination positive for PTB (HR=4.62, 95%CI: 2.98-7.19), the number of sputum smears-positive≥1 (HR=3.72, 95%CI: 2.87-4.83), non-standardized therapy regimens of PTB (HR=3.69, 95%CI: 2.95-4.64), history of retreated PTB (HR=2.22, 95%CI: 1.46-3.36), migrant adolescents (HR=1.89, 95%CI: 1.54-2.34), the number of chest X-ray scan (HR=1.83, 95%CI: 1.65-2.04), and severe PTB (HR=1.38, 95%CI: 1.02-2.05), were associated with the adverse outcome of adolescent PTB patients. Age (HR=0.94, 95%CI: 0.92-0.96), as the only protective factor, was associated with the adverse outcome of these patients. Conclusion: The management mode, molecular biological examination, chemotherapy program, history of tuberculosis, sputum smear examination, severity of tuberculosis, household residence, chest X-ray examination and age are associated with the adverse outcomes of adolescent PTB patients in Hangzhou.

Association between underlying medical conditions and fatality risk in H7N9-infected patients: a meta-analysis / 预防医学

Objective The objective of our study was to conduct meta-analyses that examined the association between H7N9-infected case-fatality risk (CFR) and underlying medical conditions (UMCs) by adjusting some potential factors variables. Methods The articles of observational studies and randomized controlled clinical trials (RCT) on the association between UMCs and the CFR of H7N9-infected patients were collected and selected according to inclusion and exclusion criteria. Meta-analysis was performed to calculate odds ratio (OR) or adjusted OR (AOR) and 95％ confidence interval (CI) to assess the association between H7N9-infected CFR and UMCs. Results Among 1934 screened articles, we identified 14 articles reporting the CFR of H7N9-infected patients based on UMCs data. The pooled summary estimates from these studies indicated that UMCs significantly increased the risk of death in H7N9 patients (OR=2.20, 95％CI: 1.76-2.76) . Subgroup analyses showed chronic respiratory diseases (CRD, OR=4.43, 95％CI: 1.73-11.31), immuno-suppressive disorders (ISD, OR=4.65, 95％ CI:1.48-44.70), and two UMCs and above (OR=2.13, 95％ CI: 1.26-5.97) were significantly associated with H7N9-infected CFR; while 60 years old and above (AOR=4.83, 95％CI: 1.29-18.09), male (AOR=2.35, 95％CI: 1.03-5.39), time intervals to oseltamivir treatment (over 5 days) (AOR=5.74, 95％ CI: 1.15-28.66) and hospitalization (over 8 days) (AOR=2.72, 95％CI: 1.20-6.15), and initially bilateral lungs infection (AOR=7.95, 95％CI: 1.56-40.41) of UMCs patients who died from H7N9 infection are much greater compared with non-UMCs. Stratification analyses confirmed statistically significant increasing effects of CFR were observed in 60 years old and above (AOR=2.20, 95％ CI: 1.12-4.30) , time intervals to oseltamivir treatment (over 5 days) (AOR=3.19, 95％CI: 1.56-6.53), and initially bilateral lungs infection (AOR=3.48, 95％CI: 1.74-6.95) compared with 0-59 years old, time intervals to oseltamivir treatment (5 days and below), and initially single lung infection respectively in H7N9-infected patients with UMCs. Conclusions We find that only CRD, ISD, and two UMCs and above are associated with increased risk of death in H7N9-infected patients. We also suggest that a high CFR is associated with 60 years old and above, delayed antiviral treatment, and initially bilateral lungs infection in H7N9-infected patients with UMCs.