Infectious Disease

COVID-19, TB coinfection linked to reduced survival

Evan Vega December 21, 2023

0 80 3 minutes read

Infographic showing median time to death based on cause.

December 20, 2023

3 min read

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

”
data-action=”subscribe”>
Subscribe

We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected].

Back to Healio

Key takeaways:

Median time to death was 21 days for COVID-19 plus tuberculosis deaths, 52 days for COVID-19 deaths and 168 days for TB deaths.
The TB mortality rate was 10.8% and the COVID-19 mortality rate was 13.1%.

Patients who died of a COVID-19 and tuberculosis coinfection had a shorter median time to death compared with patients who died of either COVID-19 or TB alone, according to results published in European Respiratory Journal.

“Most patients who died were in the group in which the COVID-19 diagnosis was before/during TB treatment [vs. after TB treatment], underscoring that concomitant TB and COVID-19 is associated with greater severity and worse outcomes and faster median time to death,” members of the Global Tuberculosis Network and TB/COVID-19 Global Study Group wrote.

Data were derived from Global Tuberculosis Network and TB/COVID-19 Global Study Group, et al. Eur Respir J. 2023;doi:10.1183/13993003.00925-2023.

To determine the long-term outcomes of a COVID-19 and TB coinfection, the study group assessed 788 patients (mean age, 45.5 years; 67.8% men) from 174 centers in 31 countries who had both infections between March 2020 and September 2022.

Results showed COVID-19 was more often the reason for hospitalization vs. TB (44.3% vs. 38.5%) as well as for use of mechanical ventilation (4.4% vs. 2%) and supplemental oxygen (19.2% vs. 11%).

Among those with data on the time of their diagnoses (n = 777), COVID-19 occurred before/during TB treatment among 495 patients — 59.8% of whom contracted COVID-19 before treatment, 14.9% during treatment and 25.3% within the same week — and after TB treatment among 282 patients. A majority (72.3%) of patients diagnosed after TB treatment finished the treatment more than a year before their COVID-19 infection.

Looking specifically at TB outcomes, researchers observed that 77.2% of patients achieved treatment success, with higher rates of success among patients who received their COVID-19 diagnosis after vs. before/during TB treatment (90.8% vs. 69.7%; P < .0001).

“TB treatment success and completion of treatment was greater when the diagnosis of COVID-19 occurred after the end of TB treatment; that is, when the diagnosis of the two diseases was not concomitant,” researchers wrote.

Researchers noted 85 deaths, for a TB mortality rate of 10.8%. Of them, 46 died of TB and COVID-19, 17 died of TB and nine died of COVID-19. The remaining deaths were caused by TB, COVID-19 and “other” (n = 4) or “other” (n = 9).

Looking specifically at COVID-19 outcomes, researchers noted COVID-19 recovery appeared more likely when it was diagnosed prior to/during vs. after TB treatment (76.3% vs. 60.1%; P < .0001). Of the 102 deaths (13.1% morality rate), 38 died of COVID-19 alone, six died of COVID-19 plus “other,” seven died of “other,” one died of TB, and the remainder died of coinfections as noted above.

Researchers found that patients who died of both COVID-19 and TB had a shorter median time to death (21 days; interquartile range [IQR], 8-90 days) compared with patients who died of COVID-19 (52 days; IQR, 30.5-227.5 days) or TB (168 days; IQR, 45.3-342.8 days; P < .001) alone.

Using Cox proportional risk-regression models, researchers looked at risk factors for overall mortality and for mortality attributable to either TB or COVID-19.

Adjusted risk factors for overall mortality in this cohort included a supplemental oxygen requirement (adjusted HR = 3.77; 95% CI, 1.98-7.17), invasive ventilation (aHR = 2.28; 95% CI, 1.39-3.72) and age (aHR = 1.03; 95% CI, 1.02-1.05).

Adjusted risk factors for both TB mortality and COVID-19 mortality included older age (aHR = 1.05; 95% CI, 1.03-1.07; aHR = 1.03; 95% CI, 1.02-1.04) and invasive ventilation (aHR = 4.28; 95% CI, 2.34-7.83; aHR = 2.19; 95% CI, 1.36-3.53).

Having an HIV infection (aHR = 2.29; 95% CI, 1.02-5.16) was only a significant risk factor for TB mortality, whereas needing supplemental oxygen (aHR = 7.93; 95% CI, 3.44-18.26) and male sex (aHR = 2.21; 95% CI, 1.24-3.91) were significant risk factors only for COVID-19 mortality.