Kumwichar Ponlagrit, Chongsuvivatwong Virasakdi
Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Rd, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand.
EClinicalMedicine. 2023 Feb;56:101825. doi: 10.1016/j.eclinm.2023.101825. Epub 2023 Jan 20.
A three-fold increase in the incidence of detecting pulmonary tuberculosis (PTB) in patients hospitalised with COVID-19 pneumonia compared with that in the general population was recently reported; however, this finding may be due to admission bias in the diagnostic investigation. The current cohort study aimed to estimate the risk of having detectable active PTB after SARS-CoV-2 infection.
Insurance claims data in lower Southern Thailand from the 12th regional National Health Security Office, Thailand, were used. Inpatient and outpatient electronic medical records were linked using encrypted identification numbers. Records of individuals aged ≥18 years from 1 April to 30 September 2021 were retrieved to form a dynamic cohort. Exposure status was based on SARS-CoV-2 investigation and pneumonia status: population control (general population who had never been tested), negative reverse transcription-polymerase chain reaction (RT-PCR) control, asymptomatic COVID-19, symptomatic COVID-19 without pneumonia, and COVID-19 pneumonia groups. They were tracked in the databases for subsequent bacteriologically confirmed PTB until 31 March 2022.
Overall, 4,241,201 individuals were recruited in the dynamic cohort and contributed 3,108,224, 227,918, 34,251, 10,325, and 14,160 person-years in the above exposure groups, respectively. Time-varying Cox's regression was conducted using population control as reference. Hazard ratios (95% CIs) of the negative control, asymptomatic, symptomatic COVID-19 without pneumonia, and pneumonia groups were 1.58 (1.08, 2.32), 1.00 (0.25, 4.01), 2.98 (0.74, 11.98), 9.87 (5.64, 17.30) in the first 30 days and 0.97 (0.81, 1.15), 1.41 (0.92, 2.17), 3.85 (2.42, 6.13), and 7.15 (5.54, 9.22) thereafter, respectively.
Having had COVID-19 pneumonia, as opposed to the general population status, was strongly associated with a higher hazard of detectable active PTB. In tuberculosis endemic areas, patients with COVID-19 pneumonia should be closely followed up to reduce PTB-related burden.
The Fogarty International Center and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health supported the article processing charges under Award Number D43TW009522.
最近有报告称，与普通人群相比，因新型冠状病毒肺炎住院的患者中肺结核（PTB）的检出率增加了两倍；然而，这一发现可能是由于诊断调查中的入院偏倚。当前的队列研究旨在评估感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后出现可检测到的活动性PTB的风险。
使用泰国第12个地区国家卫生安全办公室在泰国南部较低地区的保险理赔数据。住院和门诊电子病历通过加密的识别号码进行关联。检索2021年4月1日至9月30日年龄≥18岁个体的记录，以形成一个动态队列。暴露状态基于SARS-CoV-2检测和肺炎状态：人群对照（从未接受检测的普通人群）、逆转录聚合酶链反应（RT-PCR）阴性对照、无症状新型冠状病毒肺炎、有症状但无肺炎的新型冠状病毒肺炎以及新型冠状病毒肺炎组。在数据库中对他们进行跟踪，直至2022年3月31日，以确定随后经细菌学确诊的PTB。
总体而言，4,241,201名个体被纳入动态队列，上述暴露组分别贡献了3,108,224、227,918、34,251、10,325和14,160人年。以人群对照为参照进行了时变Cox回归分析。阴性对照、无症状、有症状但无肺炎的新型冠状病毒肺炎以及肺炎组在前30天的风险比（95%可信区间）分别为1.58（1.08, 2.32）、1.00（0.25, 4.01）、2.98（0.74, 11.98）、9.87（5.64, 17.30），此后分别为0.97（0.81, 1.15）、1.41（0.92, 2.17）、3.85（2.42, 6.13）和7.15（5.54, 9.22）。
与普通人群状态相比，患新型冠状病毒肺炎与可检测到的活动性PTB的较高风险密切相关。在结核病流行地区，应对新型冠状病毒肺炎患者进行密切随访，以减轻与PTB相关的负担。
福格蒂国际中心和美国国立卫生研究院国家过敏和传染病研究所根据资助编号D43TW009522支持了本文的文章处理费用。
