背景:及时诊断肺结核(PTB)是中断传播和优化治疗结果的全球健康优先事项。用于解决诊断中的时间延迟的传统二分法时间划分方法限制了临床应用,因为时间延迟根据所讨论的每个社区而显着变化。
目的:我们的目的是使用一种在韩国国家一级应用的新型评分系统,重新评估基于PTB疾病谱的诊断时间延迟。
方法:肺结核谱系评分(PTBSS)是根据先前发表的疾病谱相关提案制定的,通过检查全因死亡率和PTB相关死亡率来评估其有效性.在我们的分析中,我们将PTBSS纳入韩国结核病队列登记处。我们评估了各种时间延迟,包括病人,卫生保健,和整体延误,以及它们与系统相关的变量与每个PTBSS一致。此外,我们将分数重新分类为不同的轻度类别(PTBSS=0-1),中等(PBTBSS=2-3),和严重(PBTBSS=4-6)使用多元回归方法。
结果:在2018年至2020年分析数据的14031名韩国活动性PTB患者中,37%(n=5191),38%(n=5328),25%(n=3512)被归类为轻度,中度,和严重的疾病状况,分别,根据PTBSS。因此,通过考虑分数与死亡率的相关性,该分类可以反映PTB的疾病谱。时间延迟模式根据PTBSS而不同。根据PTBSS,在医疗保健延误中,更多的PTB疾病进展与更短的诊断期相关,因为这种情况在微生物学上很容易诊断。然而,关于病人的延误,随着PTB进展,经过时间的变化呈U型.这意味着,在现实世界中,患者的延迟可能会在频谱的两个顶端发生(即,在轻度和重度PTB病例中)。严重PTB模式的独立危险因素是年龄(调整后的比值比1.014)和男性(调整后的比值比1.422),而没有发现轻度PTB的显著危险因素。
结论:应及时完成PTB诊断。这可以通过使用PTBSS来改善,一个简单直观的评分系统,与传统的二分时间方法相比,这在临床和公共卫生应用中更有帮助。
BACKGROUND: Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimizing treatment outcomes. The traditional dichotomous time-divided approach for addressing time delays in diagnosis has limited clinical application because the time delay significantly varies depending on each community in question.
OBJECTIVE: We aimed to reevaluate the diagnosis time delay based on the PTB disease spectrum using a novel scoring system that was applied at the national level in the Republic of Korea.
METHODS: The Pulmonary Tuberculosis Spectrum Score (PTBSS) was developed based on previously published proposals related to the disease spectrum, and its validity was assessed by examining both all-cause and PTB-related mortality. In our analysis, we integrated the PTBSS into the Korea Tuberculosis Cohort Registry. We evaluated various time delays, including patient, health care, and overall delays, and their system-associated variables in line with each PTBSS. Furthermore, we reclassified the scores into distinct categories of mild (PTBSS=0-1), moderate (PBTBSS=2-3), and severe (PBTBSS=4-6) using a multivariate regression approach.
RESULTS: Among the 14,031 Korean patients with active PTB whose data were analyzed from 2018 to 2020, 37% (n=5191), 38% (n=5328), and 25% (n=3512) were classified as having a mild, moderate, and severe disease status, respectively, according to the PTBSS. This classification can therefore reflect the disease spectrum of PTB by considering the correlation of the score with mortality. The time delay patterns differed according to the PTBSS. In health care delays according to the PTBSS, greater PTB disease progression was associated with a shorter diagnosis period, since the condition is microbiologically easy to diagnose. However, with respect to patient delays, the change in elapsed time showed a U-shaped pattern as PTB progressed. This means that a remarkable patient delay in the real-world setting might occur at both apical ends of the spectrum (ie, in both mild and severe cases of PTB). Independent risk factors for a severe PTB pattern were age (adjusted odds ratio 1.014) and male sex (adjusted odds ratio 1.422), whereas no significant risk factor was found for mild PTB.
CONCLUSIONS: Timely PTB diagnosis should be accomplished. This can be improved with use of the PTBSS, a simple and intuitive scoring system, which can be more helpful in clinical and public health applications compared to the traditional dichotomous time-only approach.