Male Sex Is Associated With Worse Microbiological and Clinical Outcomes Following Tuberculosis Treatment: A Retrospective Cohort Study, a Systematic Review of the Literature, and Meta-analysis

被引:27
作者
Chidambaram, Vignesh [1 ]
Tun, Nyan Lynn [2 ]
Majella, Marie Gilbert [3 ]
Castillo, Jennie Ruelas [1 ]
Ayeh, Samuel K. [1 ]
Kumar, Amudha [4 ]
Neupane, Pranita [1 ]
Sivakumar, Ranjith Kumar [5 ]
Win, Ei Phyo [6 ]
Abbey, Enoch J. [7 ]
Wang, Siqing [1 ]
Zimmerman, Alyssa [1 ]
Blanck, Jaime [8 ]
Gupte, Akshay [1 ]
Wang, Jann-Yuan [9 ]
Karakousis, Petros C. [1 ,2 ]
机构
[1] Johns Hopkins Sch Med, Dept Med, Div Infect Dis, Baltimore, MD 21287 USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA
[3] Jawaharlal Inst Postgrad Med Educ & Res, Dept Prevent & Social Med, Pondicherry, India
[4] Univ Arkansas Med Sci, Dept Internal Med, Little Rock, AR USA
[5] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Anaesthesia & Intens Care, Hong Kong, Peoples R China
[6] Yangon Childrens Hosp, Dept Pathol, Yangon, Myanmar
[7] Johns Hopkins Sch Med, Dept Med, Div Endocrinol, Baltimore, MD 21287 USA
[8] Johns Hopkins Univ, Welch Med Lib, Baltimore, MD USA
[9] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei, Taiwan
基金
美国国家卫生研究院;
关键词
culture; female; HIV; mortality; sputum; GENDER; SUSCEPTIBILITY; MACROPHAGES; ACTIVATION; INFECTION; HORMONES; DISEASE; HIV;
D O I
10.1093/cid/ciab527
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Although the incidence of tuberculosis is higher in men than in women, the relationship of sex with tuberculosis treatment outcomes has not been adequately studied. Methods. We performed a retrospective cohort study and a systematic review and meta-analysis of observational studies during the last 10 years to assess sex differences in clinical and microbiological outcomes in tuberculosis. Results. In our cohort of 2894 Taiwanese patients with drug-susceptible pulmonary tuberculosis (1975 male and 919 female), male patients had higher adjusted hazards of 9-month mortality due to all causes (hazard ratio, 1.43 [95% confidence interval (CI), 1.03-1.98]) and infections (1.70 [1.09-2.64]) and higher adjusted odds of 2-month sputum culture positivity (odds ratio [OR], 1.56 [95% CI, 1.05-2.33]) compared with female patients. Smear positivity at 2 months did not differ significantly (OR, 1.27 [95% CI,.71-2.27]) between the sexes. Among 7896 articles retrieved, 398 were included in our systematic review describing a total of 3 957 216 patients. The odds of all-cause mortality were higher in men than in women in the pooled unadjusted (OR, 1.26 [95% CI, 1.19-1.34]) and adjusted (1.31 [1.18-1.45]) analyses. Men had higher pooled odds of sputum culture (OR, 1.44 [95% CI, 1.14-1.81]) and sputum smear (1.58 [1.41-1.77]) positivity, both at the end of the intensive phase and on completion of treatment. Conclusions. Our retrospective cohort showed that male patients with tuberculosis have higher 9-month all-cause and infectionrelated mortality, with higher 2-month sputum culture positivity after adjustment for confounding factors. In our meta-analysis, male patients showed higher all-cause and tuberculosis-related mortality and higher sputum culture and smear positivity rates during and after tuberculosis treatment.
引用
收藏
页码:1580 / 1588
页数:9
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