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首页> 外文期刊>EBioMedicine >Tuberculous Pericarditis is Multibacillary and Bacterial Burden Drives High Mortality
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Tuberculous Pericarditis is Multibacillary and Bacterial Burden Drives High Mortality

机译：结核性心包炎是多发性细菌和细菌负担，导致高死亡率

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Background: Tuberculous pericarditis is considered to be a paucibacillary process; the large pericardial fluid accumulation is attributed to an inflammatory response to tuberculoproteins. Mortality rates are high. We investigated the role of clinical and microbial factors predictive of tuberculous pericarditis mortality using the artificial intelligence algorithm termed classification and regression tree (CART) analysis. Methods: Patients were prospectively enrolled and followed in the Investigation of the Management of Pericarditis (IMPI) registry. Clinical and laboratory data of 70 patients with confirmed tuberculous pericarditis, including time-to-positive (TTP) cultures from pericardial fluid, were extracted and analyzed for mortality outcomes using CART. TTP was translated to log"1"0 colony forming units (CFUs) per mL, and compared to that obtained from sputum in some of our patients. Findings: Seventy patients with proven tuberculous pericarditis were enrolled. The median patient age was 35 (range: 20-71) years. The median, follow up was for 11.97 (range: 0.03-74.73) months. The median TTP for pericardial fluid cultures was 22 (range: 4-58) days or 3.91(range: 0.5-8.96) log"1"0CFU/mL, which overlapped with the range of 3.24-7.42 log"1"0CFU/mL encountered in sputum, a multi-bacillary disease. The overall mortality rate was 1.43 per 100 person-months. CART identified follow-up duration of 5.23months on directly observed therapy, a CD4+ count of @?199.5/mL, and TTP@?14days (bacillary load>=5.53 log"1"0 CFU/mL) as predictive of mortality. TTP interacted with follow-up duration in a non-linear fashion. Interpretation: Patients with culture confirmed tuberculous pericarditis have a high bacillary burden, and this bacterial burden drives mortality. Thus proven tuberculosis pericarditis is not a paucibacillary disease. Moreover, the severe immunosuppression suggests limited inflammation. There is a need for the design of a highly bactericidal regimen for this condition.
机译：背景：结核性心包炎被认为是脓疱性过程。心包积液过多归因于对结核蛋白的炎症反应。死亡率很高。我们使用称为分类和回归树（CART）分析的人工智能算法调查了预测结核性心包炎死亡率的临床和微生物因素的作用。方法：对患者进行前瞻性研究，并对其进行心包炎管理（IMPI）注册管理调查。提取并确诊结核性心包炎的70例患者的临床和实验室数据，包括心包积液的阳性反应时间（TTP）培养，并使用CART分析死亡率。将TTP转换为每毫升对数“ 1” 0菌落形成单位（CFU），并与我们某些患者的痰中获得的菌落形成单位进行比较。结果：入选了70例经证实的结核性心包炎患者。患者的中位年龄为35岁（范围：20-71岁）。中位随访时间为11.97个月（范围：0.03-74.73）。心包液体培养的中位TTP为22（范围：4-58）天或3.91（范围：0.5-8.96）log“ 1” 0CFU / mL，与3.24-7.42 log“ 1” 0CFU / mL的范围重叠痰中遇到一种多细菌性疾病。总死亡率为每100人月1.43。 CART确定直接观察疗法的随访时间为5.23个月，CD4 +计数为199.5 / mL，TTP 14天（细菌负荷> = 5.53 log“ 1” 0 CFU / mL）可预测死亡率。 TTP与随访持续时间以非线性方式相互作用。解释：经培养证实为结核性心包炎的患者有很高的细菌负担，而这种细菌负担会增加死亡率。因此，已证明的结核性心包炎不是脓疱性疾病。此外，严重的免疫抑制提示炎症有限。需要设计用于这种情况的高度杀菌方案。

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