Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in Chile

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-05-10 DOI:10.1016/j.lana.2025.101119

Vargas-García Salvador , Eduardo A. Undurraga , Nadia Escobar , Christian García , Natalia Vergara , María Elvira Balcells

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引用次数: 0

Abstract

Background

Concurrent tuberculosis (TB) and COVID-19 increases the risk of mortality; however, most studies have focused primarily on short-term outcomes. We assessed the short and long-term impact of TB and SARS-CoV-2 coinfection on all-cause mortality.

Methods

We conducted a retrospective nationwide cohort study in Chile, including adults diagnosed with active TB from January 1st, 2020, to December 31st, 2021, with follow-up until November 30th, 2022. SARS-CoV-2 coinfection was defined as occurring from 30 days before to six months after TB diagnosis. Short-term mortality was defined as death within 90 days of TB or TB/SARS-CoV-2 diagnosis, and long-term mortality as death occurring after 90 days. We used a time-dependent Cox survival analysis, adjusting for sociodemographic factors, SARS-CoV-2 vaccination, and relevant comorbidities including HIV, diabetes and Mycobacterium tuberculosis drug-resistance status.

Findings

The cohort included 3721 adults (median age: 47 years, interquartile range [IQR]: 32–61); of whom 63·4% were male, and 79·4% had pulmonary TB. The median follow-up was 586 days (IQR: 401–820), with 680 deaths (18·3%) recorded. A SARS-CoV-2 coinfection was identified in 393 individuals (10·5%); the mortality in this group was higher in short-term (≤90 days: 14·5% vs. 11·4%) and long-term (>90 days: 11·5% vs. 5·9%) compared to TB alone. Coinfection increased the risk of all-cause mortality during the entire follow-up (aHR [adjusted Hazard Ratio]: 2·8, 95% CI: 2·26–3·47), over three-fold in the short-term (aHR 3·4, 95% CI: 2·57–4·51) and nearly two-fold in the long-term (aHR: 1·72, 95% CI: 1·18–2·52). Excess mortality persisted beyond the first year (aHR: 2·04, 95% CI: 1·09–3·82). SARS-CoV-2 vaccination reduced mortality risk in the TB cohort by 35% (95% CI: 19–46%).

Interpretation

Tuberculosis and SARS-CoV-2 coinfection was associated with significantly increased all-cause mortality in both the short and long-term, with elevated risk persisting beyond TB treatment completion. These findings highlight the need for continued post-treatment follow-up and prioritization of SARS-CoV-2 vaccination among individuals with TB.

Funding

ANID-FONDECYT, Chile, and CONAHCYT, Mexico.

查看原文本刊更多论文

在一个由SARS-CoV-2感染引起的结核病队列中，全因死亡率的短期和长期风险增加：智利的一项时间依赖性生存分析

背景：并发结核病和COVID-19增加了死亡风险；然而，大多数研究主要集中在短期结果上。我们评估了结核和SARS-CoV-2合并感染对全因死亡率的短期和长期影响。方法：我们在智利进行了一项回顾性全国队列研究，包括2020年1月1日至2021年12月31日诊断为活动性结核病的成年人，随访至2022年11月30日。SARS-CoV-2合并感染被定义为发生在结核病诊断前30天至诊断后6个月。短期死亡率定义为结核或结核/SARS-CoV-2诊断后90天内的死亡，长期死亡率定义为90天后发生的死亡。我们采用了时间依赖的Cox生存分析，调整了社会人口学因素、SARS-CoV-2疫苗接种以及相关合并症，包括HIV、糖尿病和结核分枝杆菌耐药状况。研究结果：该队列包括3721名成年人（年龄中位数：47岁，四分位数间距[IQR]: 32-61）；其中男性占63.4%，肺结核占79.4%。中位随访586天（IQR: 401-820），死亡680例（18.3%）。SARS-CoV-2合并感染393例（10.5%）；该组的短期死亡率（≤90天：14.5% vs. 11.4%）和长期死亡率（≤90天：11.5% vs. 5.9%）均高于单独结核病。在整个随访期间，合并感染增加了全因死亡的风险（aHR[校正危险比]:2.8,95% CI: 2.26 - 3.47），短期增加了3倍以上（aHR: 3.4, 95% CI: 2.57 - 4.51），长期增加了近2倍（aHR: 1.72, 95% CI: 1.18 - 2.52）。超额死亡率持续超过第一年（aHR: 2.04, 95% CI: 1.09 - 3.82）。SARS-CoV-2疫苗使结核病队列的死亡风险降低了35% （95% CI: 19-46%）。结核病和SARS-CoV-2合并感染与短期和长期全因死亡率显著增加相关，并且在结核病治疗完成后风险持续升高。这些发现强调了在结核病患者中继续进行治疗后随访和优先接种SARS-CoV-2疫苗的必要性。fundingid - fondecyt，智利和CONAHCYT，墨西哥。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.