Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort

Abstract

Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19.

Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both.

Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53).

Conclusions: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes.

FIGURE 1

Global distribution of the countries/states/regions participating in the study. The following states/territories are covered in the study update: Australia (New South Wales); Canada (Ontario state); China (Wenzhou and Luzhou regions); India (New Delhi, Mumbai and Maharashtra states); Russian Federation (Arkhangelsk, Moscow and Volvograd oblasts); Switzerland (Vaud county); USA (Virginia state). 29 out of 34 countries participating in the first global study [10] provided treatment outcome updates and two countries (Nigeria and Libya) were enrolled in the study at a later stage, providing data with treatment outcomes.

FIGURE 2

Kaplan–Meier survival curves of tuberculosis (TB) deaths, coronavirus disease 2019 (COVID-19) deaths and TB+COVID-19 deaths. Log-rank test: p=0.001.