Salvador Vargas-García, Undurraga Eduardo A, Escobar Nadia, García Christian, Vergara Natalia, Balcells María Elvira
Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
Escuela de Gobierno, Pontificia Universidad Católica de Chile, Chile.
Lancet Reg Health Am. 2025 May 10;46:101119. doi: 10.1016/j.lana.2025.101119. eCollection 2025 Jun.
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.
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 drug-resistance status.
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%).
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.
ANID-FONDECYT, Chile, and CONAHCYT, Mexico.
结核病（TB）与新冠病毒（COVID-19）合并感染会增加死亡风险；然而，大多数研究主要关注短期结局。我们评估了结核病与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）合并感染对全因死亡率的短期和长期影响。
我们在智利进行了一项全国性回顾性队列研究，纳入2020年1月1日至2021年12月31日期间诊断为活动性结核病的成年人，并随访至2022年11月30日。SARS-CoV-2合并感染定义为在结核病诊断前30天至诊断后6个月内发生。短期死亡率定义为结核病或结核病/SARS-CoV-2诊断后90天内死亡，长期死亡率定义为90天后死亡。我们采用时间依赖性Cox生存分析，并对社会人口学因素、SARS-CoV-2疫苗接种情况以及包括艾滋病毒、糖尿病和耐药状态在内的相关合并症进行了调整。
该队列包括3721名成年人（中位年龄：47岁，四分位间距[IQR]：32 - 61岁）；其中63.4%为男性，79.4%患有肺结核。中位随访时间为586天（IQR：401 - 820），记录到680例死亡（18.3%）。393人（10.5%）被确定为SARS-CoV-2合并感染；与单纯结核病相比，该组在短期（≤90天：14.5%对11.4%）和长期（>90天：11.5%对5.9%）的死亡率更高。合并感染在整个随访期间增加了全因死亡风险（校正风险比[aHR]：2.8，95%置信区间[CI]：2.26 - 3.47），短期增加了三倍多（aHR 3.4，95% CI：2.57 - 4.51），长期增加了近两倍（aHR：1.72，95% CI：1.18 - 2.52）。超额死亡率在第一年之后仍然存在（aHR：2.04，95% CI：1.09 - 3.82）。SARS-CoV-2疫苗接种使结核病队列中的死亡风险降低了35%（95% CI：19 - 46%）。
结核病与SARS-CoV-2合并感染在短期和长期均与全因死亡率显著增加相关，且在结核病治疗完成后风险仍持续升高。这些发现凸显了在结核病患者中持续进行治疗后随访以及优先接种SARS-CoV-2疫苗的必要性。
智利国家科学技术研究委员会（ANID - FONDECYT）以及墨西哥国家科学技术委员会（CONAHCYT）。
