Risk factors associated with post-tuberculosis sequelae: a systematic review and meta-analysis.

IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL EClinicalMedicine Pub Date : 2024-10-21 eCollection Date: 2024-11-01 DOI:10.1016/j.eclinm.2024.102898
Temesgen Yihunie Akalu, Archie C A Clements, Alemneh Mekuriaw Liyew, Beth Gilmour, Megan B Murray, Kefyalew Addis Alene
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Abstract

Background: Post-tuberculosis (TB) sequelae present a significant challenge in the management of TB survivors, often leading to persistent health issues even after successful treatment. Identifying risk factors associated with post-TB sequelae is important for improving outcomes and quality of life of TB survivors. This systematic review and meta-analysis aims to identify risk factors associated with long-term physical sequelae among TB survivors.

Methods: We systematically searched Medline, Embase, PROQUEST, and Scopus for studies on long-term physical sequelae among TB survivors up to December 12, 2023. The primary outcome of interest was to quantify risk factors of long-term physical sequelae (i.e., respiratory, hepatic, hearing, neurological, visual, renal, and musculoskeletal sequelae). We included all forms of TB patients who experienced long-term physical sequelae. We used narrative synthesis for risk factors reported once and random-effect meta-analysis for primary outcomes with two or more studies. Findings were presented with odds ratios (OR) and 95% confidence intervals (CI). Publication bias was assessed using funnel plots and Egger regression, and heterogeneity was examined with a Galbraith radial plot. The protocol was registered on Prospero (CRD42021250909).

Findings: A total of 73 articles from 28 countries representing 31,553 TB-treated patients were included in the narrative synthesis, with 64 of these studies included in the meta-analysis. Risk factors associated with post-TB lung sequelae include older age (OR = 1.62, 95% CI: 1.07-2.47), previous TB treatment history (OR = 3.43, 95% CI: 2.37-4.97), smoking (OR = 1.41, 95% CI: 1.09-1.83), alcohol consumption (OR = 1.84, 95% CI: 1.04-3.25), smear-positive pulmonary TB diagnosis (OR = 3.11, 95% CI: 1.77-6.44), and the presence of radiographic evidence of pulmonary lesions at the commencement of treatment (OR = 2.04, 95% CI: 1.07-3.87). Risk factors associated with post-TB liver injury included pre-existing hepatitis (OR = 2.41, 95% CI: 1.16-6.08), previous TB treatment (OR = 2.64, 95% CI: 1.22-6.67), hypo-albuminemia (OR = 2.10, 95% CI: 1.53-2.88), HIV co-infection (OR = 2.72, 95% CI: 1.66-4.46), and CD4 count <200 mm3 in HIV-infected individuals (OR = 2.03, 95%CI: 1.26-3.27). Risk factors associated with post-TB hearing loss include baseline hearing problems (OR = 1.72, 95% CI: 1.30-2.26), and HIV co-infection (OR = 3.02, 95% CI: 1.96-4.64).

Interpretation: This systematic review and meta-analysis found that long-term physical post-TB sequelae including respiratory, hepatic, and hearing impairment were associated with a range of socio-demographic, behavioral, and clinical factors. Identification of these risk factors will help to identify patients who will benefit from interventions to reduce the burden of suffering from post-TB treatment.

Funding: Healy Medical Research Raine Foundation, the Australian National Health and Medical Research Council, and Curtin University Higher Degree Research Scholarship fund the study.

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与结核病后遗症相关的风险因素:系统回顾和荟萃分析。
背景:肺结核(TB)后遗症是肺结核幸存者管理中的一个重大挑战,即使在成功治疗后也常常导致持续的健康问题。确定与结核病后遗症相关的风险因素对于改善结核病幸存者的治疗效果和生活质量非常重要。本系统综述和荟萃分析旨在确定与肺结核幸存者长期身体后遗症相关的风险因素:我们系统检索了 Medline、Embase、PROQUEST 和 Scopus 中截至 2023 年 12 月 12 日有关结核病幸存者长期身体后遗症的研究。我们关注的主要结果是量化长期身体后遗症(即呼吸系统、肝脏、听力、神经系统、视觉、肾脏和肌肉骨骼后遗症)的风险因素。我们纳入了所有形式的出现长期身体后遗症的肺结核患者。我们对报告过一次的风险因素进行了叙述性综合分析,对有两项或更多研究的主要结果进行了随机效应荟萃分析。研究结果以几率比(OR)和 95% 置信区间(CI)表示。使用漏斗图和 Egger 回归评估发表偏倚,使用 Galbraith 径向图检查异质性。研究方案已在 Prospero(CRD42021250909)上注册:共有来自 28 个国家、代表 31,553 名结核病患者的 73 篇文章被纳入叙述性综述,其中 64 项研究被纳入荟萃分析。与结核病后肺部后遗症相关的风险因素包括年龄较大(OR = 1.62,95% CI:1.07-2.47)、既往结核病治疗史(OR = 3.43,95% CI:2.37-4.97)、吸烟(OR = 1.41,95% CI:1.09-1.83)、饮酒(OR = 1.84,95% CI:1.04-3.25)、肺结核诊断涂片阳性(OR = 3.11,95% CI:1.77-6.44)以及治疗开始时存在肺部病变的影像学证据(OR = 2.04,95% CI:1.07-3.87)。与结核病后肝损伤相关的危险因素包括:既往存在肝炎(OR = 2.41,95% CI:1.16-6.08)、既往接受过结核病治疗(OR = 2.64,95% CI:1.22-6.67)、低白蛋白血症(OR = 2.10,95% CI:1.53-2.88)、HIV 合并感染(OR = 2.72,95% CI:1.66-4.46)和 HIV 感染者的 CD4 细胞计数 3(OR = 2.03,95% CI:1.26-3.27)。与结核病后听力损失相关的风险因素包括基线听力问题(OR = 1.72,95% CI:1.30-2.26)和艾滋病病毒合并感染(OR = 3.02,95% CI:1.96-4.64):这项系统综述和荟萃分析发现,结核病后的长期身体后遗症(包括呼吸系统、肝脏和听力损伤)与一系列社会人口、行为和临床因素有关。识别这些风险因素将有助于确定哪些患者将从干预措施中受益,从而减轻结核病治疗后的痛苦负担:希利医学研究雷恩基金会(Healy Medical Research Raine Foundation)、澳大利亚国家健康与医学研究委员会(Australian National Health and Medical Research Council)和科廷大学高等教育研究奖学金(Curtin University Higher Degree Research Scholarship)资助了这项研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
EClinicalMedicine
EClinicalMedicine Medicine-Medicine (all)
CiteScore
18.90
自引率
1.30%
发文量
506
审稿时长
22 days
期刊介绍: eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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