在前抗生素时代,结核的死亡率超过50%,但是抗生素时代的来临使得结核成为可治愈的疾病。在2010年美国,根据最新数据,在11 163报告患者中,569名患者死亡(致死率5%)。[9]Centers for Disease Control and Prevention. Reported tuberculosis in the United States, 2013. September 2014. http://www.cdc.gov/tb/ (last accessed 16 December 2016).http://www.cdc.gov/tb/statistics/reports/2013/default.htm死亡风险有高龄,延误诊断,结核累及广泛,机械通气,合并终末期肾病,糖尿病和免疫抑制状态,特别是HIV感染。[88]Anyama N, Bracebridge S, Black C, et al. What happens to people diagnosed with tuberculosis? A population-based cohort. Epidemiol Infect. 2007;135:1069-1076.http://www.ncbi.nlm.nih.gov/pubmed/17288641?tool=bestpractice.com[89]Fielder JF, Chaulk CP, Dalvi M, et al. A high tuberculosis case-fatality rate in a setting of effective tuberculosis control: implications for acceptable treatment success rates. Int J Tuberc Lung Dis. 2002;6:1114-1117.http://www.ncbi.nlm.nih.gov/pubmed/12546121?tool=bestpractice.com一项荟萃分析显示,在结核治疗中,HIV阴性患者的死亡率为3.5%,而HIV阳性患者的死亡率为18.8%。[90]Straetemans M, Glaziou P, Bierrenbach AL, et al. Assessing tuberculosis case fatality ratio: a meta-analysis. PLoS One. 2011;6:e20755.http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0020755http://www.ncbi.nlm.nih.gov/pubmed/21738585?tool=bestpractice.com
结核性脑膜炎的死亡率高达35%且可能留有永久的神经系统后遗症。儿童伴有进展性疾病和神经系统合并症的预后不佳。[5]Thwaites G, Chau TT, Mai NT, et al. Tuberculous meningitis. J Neurol Neurosurg Psych. 2000;68:289-299.http://www.ncbi.nlm.nih.gov/pubmed/10675209?tool=bestpractice.com
如果治疗延迟超过6周以上,结核性腹膜炎的死亡率超过60%。[15]Chow KM, Chow VC, Hung LC, et al. Tuberculous peritonitis-associated mortality is high among patients waiting for the results of mycobacterial cultures of ascitic fluid samples. Clin Infect Dis. 2002;35:409-413.http://www.ncbi.nlm.nih.gov/pubmed/12145724?tool=bestpractice.com
在播散型结核,有报告死亡率高达38%。诊断和治疗延迟与高死亡率有关。[91]Long R, O'Connor R, Palayew M, et al. Disseminated tuberculosis with and without a miliary pattern on chest radiograph: a clinical-pathologic-radiologic correlation. Int J Tuberc Lung Dis. 1997;1:52-58.http://www.ncbi.nlm.nih.gov/pubmed/9441059?tool=bestpractice.com