糖尿病和低体重指数个体在耐多药结核病治疗期间的高死亡率
High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index.
作者信息
Veeken Lara D, Kulsum Iceu D, Lestari Bony W, Santoso Prayudi, Soetedjo Nanny N M, Koesoemadinata Raspati C, Miranda Adriana V, Sukmawati Wini, Salindri Argita D, Soeroto Arto Y, van Crevel Reinout
机构信息
Department of Internal Medicine and Radboud Community for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Internal Medicine, Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia.
出版信息
Open Forum Infect Dis. 2025 Jun 25;12(7):ofaf344. doi: 10.1093/ofid/ofaf344. eCollection 2025 Jul.
BACKGROUND
Diabetes is a risk factor for mortality during rifampicin-resistant tuberculosis (RR-TB) treatment, but whether its impact differs by nutritional status is unknown. We estimated the effect of diabetes and its interaction with low body mass index (BMI) (ie, <18.5 kg/m) on all-cause mortality during treatment of RR-TB.
METHODS
We used medical record data of adults treated for RR-TB in Indonesia between March 2020 and May 2022. Diabetes was defined as glycated hemoglobin ≥6.5% or prior diabetes diagnosis by healthcare providers. Cox proportional hazards regression was used to estimate the hazard rates of mortality during treatment comparing those with and without diabetes. Multiplicative and additive interactions were evaluated to determine if the effect of diabetes on mortality during treatment was moderated by BMI status.
RESULTS
Among 345 individuals (57% male, 1.7% with human immunodeficiency virus, 59% with BMI <18.5 kg/m), 96 (28%) had diabetes and 62 (18%) died. Adjusting for confounders, the hazard rates of mortality during treatment were higher among those with diabetes (adjusted hazard rate ratio [aHR], 2.05 [95% CI, 1.17-3.58]) or those with BMI <18.5 kg/m (aHR, 2.33 [95% CI, 1.28-4.21]). No significant multiplicative nor additive interaction was detected, but the hazard rates of mortality were highest among those with diabetes and BMI <18.5 kg/m (aHR, 7.14 [95% CI, 2.71-18.82]) compared to those without diabetes and BMI ≥18.5 kg/m.
CONCLUSIONS
Having diabetes doubled the risk of mortality during RR-TB treatment. Highest mortality rates were observed among individuals with combined diabetes and low BMI.
背景
糖尿病是耐利福平结核病（RR-TB）治疗期间死亡的一个危险因素，但其影响是否因营养状况而异尚不清楚。我们估计了糖尿病及其与低体重指数（BMI，即<18.5 kg/m²）的相互作用对RR-TB治疗期间全因死亡率的影响。
方法
我们使用了2020年3月至2022年5月在印度尼西亚接受RR-TB治疗的成年人的病历数据。糖尿病定义为糖化血红蛋白≥6.5%或之前经医疗保健提供者诊断为糖尿病。采用Cox比例风险回归来估计治疗期间有糖尿病和无糖尿病患者的死亡风险率。评估乘法和加法相互作用，以确定糖尿病对治疗期间死亡率的影响是否受BMI状态的调节。
结果
在345名个体中（57%为男性，1.7%感染人类免疫缺陷病毒，59%的BMI<18.5 kg/m²），96人（28%）患有糖尿病，62人（18%）死亡。在调整混杂因素后，糖尿病患者（调整后风险率比值[aHR]，2.05[95%置信区间，1.17-3.58]）或BMI<18.5 kg/m²的患者（aHR，2.33[95%置信区间，1.28-4.21]）治疗期间的死亡风险率更高。未检测到显著的乘法或加法相互作用，但与无糖尿病且BMI≥18.5 kg/m²的患者相比，糖尿病且BMI<18.5 kg/m²的患者的死亡风险率最高（aHR，7.14[95%置信区间，2.71-18.82]）。
结论
患有糖尿病使RR-TB治疗期间的死亡风险加倍。糖尿病合并低BMI的个体死亡率最高。
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