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Risk factors for the adverse course of COVID-19 in patients with tuberculosis

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Abstract

DOI: 10.32364/2587-6821-2024-8-11-1

N.D. Urushadze¹, N.Yu. Pshenichnaya^2,3, L.E. Parolina¹, V.S. Burykhin¹, S.N. Skornyakov⁴, I.A. Vasilyeva^1,5

¹National Medical Research Center of Phtisiopulmonology, Moscow, Russian Federation

²Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russian Federation

³Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation

⁴Ural Scientific Research Institute of Phtisiopulmonology — Branch of the National Medical Research Center of Phtisiopulmonology, Yekaterinburg, Russian Federation

⁵Pirogov Russian National Research Medical University, Moscow, Russian Federation

Aim: to elucidate the clinical progression patterns of coronavirus infection (COVID-19) in hospitalized patients with tuberculosis (TB) and to identify predictors of adverse (fatal) outcomes of the disease.

Materials and Methods: a retrospective analysis was conducted on the clinical progression of COVID-19, encompassing 178 patients in total. This cohort included 80 patients diagnosed with COVID-19 monoinfection and 98 patients with co-infection (COVID-19 and TB), all hospitalized for COVID-19 treatment between January 2021 and December 2022.

Results: patients with concurrent COVID-19 and TB were admitted to hospital at earlier stages of COVID-19. Consequently, this group presented with milder disease severity and lacked significant clinical symptoms upon admission. Despite this, the co-infected group exhibited a greater risk of adverse outcomes. Initial laboratory evaluations for this cohort, conducted at the earliest stage of COVID-19, indicated an active immune response to bacterial infection, as evidenced by increased neutrophil counts, reduced lymphocyte levels, and elevated erythrocyte sedimentation rate (ESR). This profile deteriorated with disease progression, exacerbated by added markers of systemic inflammation. Adverse outcomes for both COVID-19 monoinfection and COVID-19/TB co-infected patients were significantly influenced by advanced age and comorbidities. In patients without TB, chronic hepatitis and renal failure posed the greatest risk, whereas cardiovascular disorders were predominant predictors in those with TB. Additionally, indicators of respiratory distress at the time of hospitalization were significant adverse outcome predictors in both cohorts: dyspnea was a critical factor in patients with COVID-19 alone, whereas blood oxygen saturation (SpO2 levels) was particularly predictive in the COVID-19/TB group.

Conclusions: the presence of pulmonary TB exacerbates the clinical course of COVID-19. Early detection of SARS-CoV-2 in patients with TB during hospital admission could play a crucial role in preventing a more severe progression of COVID-19 in this demographic.

Keywords: COVID-19, tuberculosis, COVID-19/TB, course severity, predictors of adverse (fatal) outcome.

For citation: Urushadze N.D., Pshenichnaya N.Yu., Parolina L.E., Burykhin V.S., Skornyakov S.N., Vasilyeva I.A. Risk factors for the adverse course of COVID-19 in patients with tuberculosis. Russian Medical Inquiry. 2024;8(11):603–611 (in Russ.). DOI: 10.32364/2587-6821-2024-8-11-1

About the authors:

Natalia D. Urushadze — Junior Researcher of the Scientific Department of Infectious Pathology, National Medical Research Center of Phtisiopulmonology; 4, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0000-0002-1525-5992

Natalia Yu. Pshenichnaya — Dr. Sc. (Med.), Professor, Deputy Director for Clinical and Analytical Work, Central Research Institute of Epidemiology of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; 3A, Novogireevskaya str., Moscow, 111123, Russian Federation; Head of the Department of Infectious Diseases, Russian Medical Academy of Continuous Professional Education; 2/1, build. 1, Barricadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0003-2570-711X

Lyubov E. Parolina — Dr. Sc. (Med.), Professor, Head of the Education Center, National Medical Research Center of Phtisiopulmonology; 4, Dostoevsky str., Moscow, 127473, Russian Federation; ORCID iD 0000-0003-4365-5894

Valery S. Burykhin — Head of the Department of Analysis and Statistics of Infectious Diseases, National Medical Research

Center of Phtisiopulmonology; 4, Dostoevsky str., Moscow, 127473, Russian Federation.

Sergey N. Skornyakov — Dr. Sc. (Med.), Professor, Head of the Research Clinical Department, Ural Scientific Research Institute of Phtisiopulmonology — Branch of the National Medical Research Center of Phtysiopulmonology; 50, 22nd Partsiezda, Yekaterinburg, 620039, Russian Federation; ORCID iD 0000-0002-9942-3008

Irina A. Vasilyeva — Dr. Sc. (Med.), Professor, Director of the National Medical Research Center of Phtisiopulmonology; 4, Dostoevsky str., Moscow, 127473, Russian Federation; Head of the Department of Phthisiology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0002-0637-7955

Contact information: Natalia D. Urushadze, e-mail: nataliu98@mail.ru

Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.

There is no conflict of interest.

Received 11.09.2024.

Revised 04.10.2024.

Accepted 29.10.2024.

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