Anemia and anti-tuberculosis treatment outcome in persons with pulmonary tuberculosis: A multi-center prospective cohort study
Year: 2023
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Tuberculosis (TB) remains a major plague of humanity. People with TB (PWTB) are commonly anemic. Here, we assessed whether the severity of anemia in PWTB prior to anti-TB treatment (ATT) was a risk factor for an unfavorable outcome. METHODS: Patients ≥ 18 years old with culture-confirmed drug-susceptible pulmonary TB enrolled between 2015 and 2019 in a multi-center Brazilian cohort were followed for up to 24 months and classified according to anemia severity (mild, moderate, and severe), based on hemoglobin levels. A multinomial logistic regression model was employed to assess whether anemia was associated with unfavorable outcome (death, failure, loss to follow-up, regimen modification or relapse), compared to treatment success (cure or treatment completion). RESULTS: Among 786 participants who met inclusion criteria, 441 (56 %) were anemic at baseline. Patients with moderate/severe anemia were more HIV-seropositive, as well as more symptomatic and had higher frequencies of unfavorable outcomes compared to the other groups. Moderate/severe anemia (adjusted OR [aOR]: 7.80, 95 %CI:1.34-45.4, p = 0.022) was associated with death independent of sex, age, BMI, HIV and glycemic status. CONCLUSION: Moderate/severe anemia prior to ATT was a significant risk factor for death. Such patients should be closely monitored given the high risk of unfavorable ATT outcomes.
Authors: Mariana Araújo-Pereira, Betânia M.F. Nogueira, Renata Spener-Gomes, Anna C.C. Carvalho, Flávia Marinho Sant’Anna, Marina C. Figueiredo, Megan M. Turner, Afrânio L. Kritski, Marcelo Cordeiro-Santos, Valeria C. Rolla, Timothy R. Sterling, Bruno B. Andrade, Alice M.S. Andrade, Vanessa Nascimento, Juan Manuel Cubillos-Angulo, Hayna Malta-Santos, Jéssica Rebouças-Silva, Saulo R.N. Santos, André Ramos, Pedro Brito, Carolina A.S. Schmaltz, Alysson G. Costa, Leandro Sousa Garcia, Brenda K. de Sousa Carvalho, Bruna P. de Loiola, Adriano Gomes-Silva, Francine P. Ignácio, Maria C. Lourenço, Elisangela C. Silva, Mayla Mello, Alexandra B. Souza, Beatriz Barreto-Duarte, Michael S. Rocha, Aline Benjamin, Adriana S.R. Moreira, Jamile G. de Oliveira, Solange Cavalcante, Betina Durovni, José R. Lapa-e-Silva
Institutions: Universidade Federal da Bahia, Faculdade de Tecnologia e Ciências, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Fundação de Medicina Tropical, Universidade do Estado do Amazonas, Universidade Federal do Amazonas, Universidade Federal do Rio de Janeiro, Instituto Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Vanderbilt University, Universidade Nilton Lins
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
Funders: Vanderbilt University, British Burn Association, Vanderbilt University Medical Center, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Ministério da Saúde, Fundação Oswaldo Cruz, National Institute of Allergy and Infectious Diseases, Mass Communication and Society Division
Awards: G2400402274, Immunogenetic predictors of active and incipient TB in HIV-negative and -positive close TB contacts, G615457062, Regional Prospective Observational Research in Tuberculosis (RePORT) – Brazil Network, Caribbean, Central, and South America network for HIV Epidemiology (CCASAnet), Inflammatory determinants of disease severity and treatment outcome in TB patients
OpenAlex ID: W4366245652