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. 2022 Nov 28;48(6):e20210505.
doi: 10.36416/1806-3756/e20210505. eCollection 2022.

Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes

[Article in English, Portuguese]
André Luiz Bezerra  1 , Adriana da Silva Rezende Moreira  1 , Lorrayne Isidoro-Gonçalves  2 , Carla F Dos Santos Lara  1   3 , Gustavo Amorim  4 , Elisangela C Silva  1   5   6   7 , Afrânio Lineu Kritski  1 , Anna Cristina C Carvalho  1   2
Affiliations

Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes

[Article in English, Portuguese]
André Luiz Bezerra et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculosis treatment outcomes.

Methods: This was a longitudinal study involving 140 patients diagnosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the patients were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes mellitus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglobin levels (< 5.7%, 5.7%-6.4%, and ≥ 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure).

Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%).

Conclusions: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.

Objetivo:: Analisar a associação de disglicemia e características clínicas, laboratoriais e radiográficas em pacientes com tuberculose pulmonar (TBP), bem como a associação de disglicemia e desfechos do tratamento da tuberculose.

Métodos:: Estudo longitudinal com 140 pacientes com diagnóstico de TBP (culturas de escarro positivas para Mycobacterium tuberculosis ou resultados positivos do teste Xpert MTB/RIF em amostras de escarro). Os pacientes foram avaliados no momento do diagnóstico (M0), após dois meses de tratamento (M2) e no fim do tratamento (MFIM). Em M0, os pacientes foram divididos em três grupos: normoglicemia+TBP (NGTB); pré-diabetes mellitus+TBP (PDMTB) e diabetes mellitus+TBP (DMTB), de acordo com os níveis de hemoglobina glicada (< 5,7%, 5,7%-6,4% e ≥ 6,5%, respectivamente). Os desfechos do tratamento foram classificados em favoráveis (cura ou conclusão do tratamento) e desfavoráveis (óbito, perda de seguimento ou falência do tratamento).

Resultados:: Em nossa amostra, 76 pacientes (61,4%) apresentavam disglicemia, 20 (14,3%) dos quais apresentavam DM em M0. Os pacientes com disglicemia, em comparação com os do grupo NGTB, apresentaram mais frequentemente baciloscopia de escarro positiva (94,2% vs. 75,9%; p = 0,003); cavidades (80,2% vs. 63,0%; p = 0,03); lesões bilaterais (67,4% vs. 46,0%; p = 0,02) e maior mediana de terços pulmonares acometidos (3,0 vs. 2,0; p = 0,03) na radiografia de tórax. Não foram observadas diferenças significativas entre os grupos quanto aos desfechos, mas a letalidade da tuberculose foi maior no grupo DMTB do que nos grupos PDMTB e NGTB (20% vs. 2,2%).

Conclusões:: Pacientes com TBP e disglicemia apresentaram manifestações laboratoriais e radiográficas indicativas de doença mais avançada, e o risco de óbito foi maior no grupo DMTB. Esses achados reforçam a recomendação de detecção precoce de DM em pacientes com tuberculose recém-diagnosticada, a fim de reduzir o risco de óbito durante o tratamento.

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Conflict of interest statement

CONFLICTS OF INTEREST: None declared.

Figures

Figure 1
Figure 1. Proportion of patients diagnosed with pulmonary tuberculosis regarding glycemic state (determined by glycated hemoglobin levels) at three moments of evaluation: at the diagnosis of tuberculosis (M0; n = 140); after completing the second month of treatment (M2; n = 99); and at the end of tuberculosis treatment (MEND; n = 86). DM: diabetes mellitus.
Figure 2
Figure 2. Box plots showing glycated hemoglobin levels at the diagnosis of pulmonary tuberculosis in patients with pulmonary tuberculosis whose outcome was survival or death. *Nonparametric Wilcoxon-Mann-Whiney test.
See this image and copyright information in PMC

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