Anemia and anti-tuberculosis treatment outcome in persons with pulmonary tuberculosis: A multi-center prospective cohort study
Mariana Araújo‐Pereira, Betânia M. F. Nogueira, Renata Spener-Gomes, Anna Cristina Calçada Carvalho, Flávia Marinho Sant’Anna, Marina C. Figueiredo, Megan Turner, Afrânio Lineu Kritski, Marcelo Cordeiro‐Santos, Valéria C. Rolla, Timothy R. Sterling, Bruno B. Andrade, Alice M S Andrade, Vanessa Nascimento, Juan M. Cubillos-Angulo, Hayna Malta‐Santos, Jéssica Rebouças-Silva, Saulo R N Santos, André Ramos, Pedro Brito, Carolina AranaStanis Schmaltz, Allyson Guimarães Costa, Leandro Sousa Garcia, Brenda K. de Sousa Carvalho, Bruna P. de Loiola, Adriano Gomes-Silva, Francine P Ignácio, Maria Cristina S. Lourenço, Elisângela 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 Roberto Lapa e Silva
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.