Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in Chile

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dc.article.number101119
dc.catalogadorgjm
dc.contributor.authorVargas García, Salvador
dc.contributor.authorUndurraga, Eduardo A.
dc.contributor.authorEscobar, Nadia
dc.contributor.authorGarcía, Christian
dc.contributor.authorVergara, Natalia
dc.contributor.authorBalcells Marty, María Elvira
dc.date.accessioned2025-05-22T13:59:13Z
dc.date.available2025-05-22T13:59:13Z
dc.date.issued2025
dc.description.abstractBackground: Concurrent tuberculosis (TB) and COVID-19 increases the risk of mortality; however, most studies have focused primarily on short-term outcomes. We assessed the short and long-term impact of TB and SARS-CoV-2 coinfection on all-cause mortality. Methods: We conducted a retrospective nationwide cohort study in Chile, including adults diagnosed with active TB from January 1st, 2020, to December 31st, 2021, with follow-up until November 30th, 2022. SARS-CoV-2 coinfection was defined as occurring from 30 days before to six months after TB diagnosis. Short-term mortality was defined as death within 90 days of TB or TB/SARS-CoV-2 diagnosis, and long-term mortality as death occurring after 90 days. We used a time-dependent Cox survival analysis, adjusting for sociodemographic factors, SARS-CoV-2 vaccination, and relevant comorbidities including HIV, diabetes and Mycobacterium tuberculosis drug-resistance status. Findings: The cohort included 3721 adults (median age: 47 years, interquartile range [IQR]: 32–61); of whom 63·4% were male, and 79·4% had pulmonary TB. The median follow-up was 586 days (IQR: 401–820), with 680 deaths (18·3%) recorded. A SARS-CoV-2 coinfection was identified in 393 individuals (10·5%); the mortality in this group was higher in short-term (≤90 days: 14·5% vs. 11·4%) and long-term (>90 days: 11·5% vs. 5·9%) compared to TB alone. Coinfection increased the risk of all-cause mortality during the entire follow-up (aHR [adjusted Hazard Ratio]: 2·8, 95% CI: 2·26–3·47), over three-fold in the short-term (aHR 3·4, 95% CI: 2·57–4·51) and nearly two-fold in the long-term (aHR: 1·72, 95% CI: 1·18–2·52). Excess mortality persisted beyond the first year (aHR: 2·04, 95% CI: 1·09–3·82). SARS-CoV-2 vaccination reduced mortality risk in the TB cohort by 35% (95% CI: 19–46%). Interpretation: Tuberculosis and SARS-CoV-2 coinfection was associated with significantly increased all-cause mortality in both the short and long-term, with elevated risk persisting beyond TB treatment completion. These findings highlight the need for continued post-treatment follow-up and prioritization of SARS-CoV-2 vaccination among individuals with TB.
dc.format.extent13 páginas
dc.fuente.origenORCID
dc.identifier.doi10.1016/j.lana.2025.101119
dc.identifier.urihttps://doi.org/10.1016/j.lana.2025.101119
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/104427
dc.information.autorucEscuela de Medicina; Vargas García, Salvador; S/I; 1186484
dc.information.autorucEscuela de Gobierno; Undurraga Fourcade, Eduardo Andrés; 0000-0002-4425-1253; 12868
dc.information.autorucEscuela de Medicina; Balcells Marty, María Elvira; 0000-0002-7223-9665; 7462
dc.language.isoen
dc.nota.accesocontenido completo
dc.revistaThe Lancet Regional Health - Americas
dc.rightsacceso abierto
dc.rights.licenseCC BY-NC-ND 4.0 Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectMycobacterium tuberculosis
dc.subjectTuberculosis
dc.subjectCOVID-19
dc.subjectSARS-CoV-2
dc.subjectGlobal health
dc.subjectCohort
dc.subjectChile
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleShort- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in Chile
dc.typeartículo
dc.volumen46
sipa.codpersvinculados1186484
sipa.codpersvinculados12868
sipa.codpersvinculados7462
sipa.trazabilidadORCID;2025-05-19
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