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. (8th June 2021)

• Record Type: Journal Article
• Authors: Chidambaram, Vignesh; Tun, Nyan Lynn; Majella, Marie Gilbert; Ruelas Castillo, Jennie; Ayeh, Samuel K; Kumar, Amudha; Neupane, Pranita; Sivakumar, Ranjith Kumar; Win, Ei Phyo; Abbey, Enoch J; Wang, Siqing; Zimmerman, Alyssa; Blanck, Jaime; Gupte, Akshay; Wang, Jann-Yuan; Karakousis, Petros C
• Is Part Of: Clinical infectious diseases. Volume 73:Number 9(2021)
• Page Start: 1580
• Page End: 1588
• Publication Date: 2021-06-08
• Subjects: culture -- female -- HIV -- mortality -- sputum; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab527
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: 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 infection-related 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. Abstract : Our retrospective cohort of Taiwanese patients with pulmonary tuberculosis and systematic review showed that male sex is associated with higher all-cause and infection-related mortality and higher sputum culture and acid-fast bacilli smear positivity during and after tuberculosis treatment.