Prevalence of anemia among patients with tuberculosis: A systematic review and meta-analysis

Barzegari, Saeed; Afshari, Mahdi; Movahednia, Mahtab; Moosazadeh, Mahmood

doi:10.1016/j.ijtb.2019.04.002

Cited by 33 publications

(44 citation statements)

References 33 publications

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“…These observations, together with the evidence of decreased MCH and MCV in patients with anemia and the significant prevalence of microcytic hypochromic anemia (27.8% of anemia cases), allow us to speculate that important causes of anemia in TB patients may be iron nutritional deficiency and/or its decreased availability to erythropoiesis due to alterations of its metabolism in inflammation. The higher platelet counts in patients with anemia may corroborate this argument because lower iron availability in the bone marrow leads to the production of megakaryocytes with higher ploidy, which may release more platelets than lower-ploidy ones [33].One study that assessed the causes of anemia estimated that 15.0% to 75.9% of cases were inflammation anemia and 0.0% to 58.0% were iron-deficiency anemia [4]. This variation may be due to different criteria and study designs.…”

Section: Plos Onementioning

confidence: 98%

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Anemia in tuberculosis cases: A biomarker of severity?

Mendonça¹,

Schmaltz²,

Sant’Anna³

et al. 2021

PLoS ONE

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Introduction Anemia is a common condition at tuberculosis diagnosis, and there is evidence that its prevalence is higher in patients with tuberculosis than in those infected with Mycobacterium tuberculosis and healthy controls. Information about anemia during tuberculosis diagnosis is still scarce in the Brazilian population. The aim of this study was to describe the prevalence of anemia in patients with tuberculosis cared for at a referral center and its association with clinical forms of tuberculosis and other characteristics of these patients. Materials and methods This was a retrospective cross-sectional study of tuberculosis patients diagnosed from January 2015 to December 2018 at the Clinical Research Laboratory on Mycobacteria (LAPCLIN-TB) of Evandro Chagas National Institute of Infectious Diseases (INI)/Oswaldo Cruz Foundation (Fiocruz). A database of an ongoing cohort study underway at this service since 2000 provided the baseline information on tuberculosis cases extracted from a visit template. Exploratory and logistic regression analyses were performed to verify associations between anemia and demographic characteristics, socioeconomic status, clinical conditions, and laboratory results. Results Of the 328 cases reviewed, 70 were excluded, with258 retained. The prevalence of anemia was 61.2% (27.5% mild, 27.5% moderate and 6.2% severe). Among patients with anemia, 60.8% had normochromic normocytic anemia, and 27.8% showed hypochromic microcytic anemia. In logistic regression analysis, anemia was associated with a history of weight loss >10%, hospitalizations, coinfection with HIV, increased platelet count and microcytosis. Anemia was more frequent in the most severe clinical forms, such as meningeal and disseminated tuberculosis. Conclusions Anemia was highly prevalent in tuberculosis patients at diagnosis, predominantly as normochromic normocytic anemia and in mild and moderate forms. It was associated with baseline characteristics and conditions indicative of severe disease, suggesting that anemia could be a biomarker of tuberculosis severity.

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Section: Plos Onementioning

confidence: 98%

“…Anemia is a common condition at TB diagnosis, with prevalence estimates ranging from 9.5% to 96%, depending on the location, study design and population studied [4]. There is evidence that anemia is more frequent in TB patients than in TB contacts infected with Mycobacterium tuberculosis [5] and healthy controls [6,7].…”

Section: Introductionmentioning

confidence: 99%

Anemia in tuberculosis cases: A biomarker of severity?

Mendonça¹,

Schmaltz²,

Sant’Anna³

et al. 2021

PLoS ONE

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“…Several causes of anemia are described, including iron deficiency and chronic inflammation ( 5 – 7 ). Prevalence of anemia in TB patients is reported to range between 32 and 96% ( 8 ), whereas in PLWH, this estimate varies from 1.3 to 95% ( 4 ). The extreme discrepancies in frequency of anemia associated with either TB and/or HIV infections published by several studies are thought to be influenced by factors that include study design, geographic location as well as clinical and epidemiological characteristics of patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of Persistent Anemia on Systemic Inflammation and Tuberculosis Outcomes in Persons Living With HIV

et al. 2020

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Tuberculosis (TB) is associated with systemic inflammation and anemia, which are aggravated in persons living with HIV (PLWH). Here, we characterized the dynamics of hemoglobin levels in PLWH coinfected with TB undergoing antitubercular therapy (ATT). We also examined the relationships between anemia and systemic inflammatory disturbance as well as the association between persistent anemia and unfavorable clinical outcomes. Data on several blood biochemical parameters and on blood cell counts were retrospectively analyzed in a cohort of 256 TB/HIV patients from Brazil during 180 days of ATT. Multidimensional statistical analyses were employed to profile systemic inflammation of patients stratified by anemia status (hemoglobin levels <12 g/dL for female and <13.5 g/dL for male individuals) prior to treatment and to perform prediction of unfavorable outcomes, such as treatment failure, loss to follow up and death. We found that 101 (63.63%) of patients with anemia at pre-ATT persisted with such condition until day 180. Such individuals exhibited heightened degree of inflammatory perturbation (DIP), which in turn was inversely correlated with hemoglobin levels. Recovery from anemia was associated with increased pre-ATT albumin levels whereas persistent anemia was related to higher total protein levels in serum. Multivariable regression analysis revealed that lower baseline hemoglobin levels was the major determinant of the unfavorable outcomes. Our findings demonstrate that persistent anemia in PLWH during the course of ATT is closely related with chronic inflammatory perturbation. Early intervention to promote recovery from anemia may improve ATT outcomes.

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“…Anemia is a common comorbidity in TB with a decreased level of Hb. Prevalence of anemia in TB patients ranged between 32% and 96% [18], most of which were due to anemia of in ammation [19,20]. Previous evidence had showed an unambiguous relationship between anemia, iron redistribution and TB susceptibility [21], moreover anemia was correlated with poor clinical prognoses and mortality after TB diagnosis [20].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of a Five-Biomarker Signature to Diagnose Active Pulmonary Tuberculosis Patients

Zeng

Yang

et al. 2021

Preprint

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Background: To improve the diagnosis accuracy of active pulmonary tuberculosis (TB) from pneumonia (PN) in low income and inadequate facilities areas is one of the biggest problems facing public health today. Most TB patients are difficult to diagnose, especially those who are acid-fast bacillus smear-negative (AFB-) but IGRA®.TB test positive (IGRA+). Thus, we aim to develop a low-cost and rapid risk model for the diagnosis of TB patients with AFB- IGRA+ TB from PN.Methods: We retrospectively analyzed 41 laboratory variables of 204 AFB- IGRA+ TB and 156 PN participants. Candidate variables were identified by t-statistic test and univariate logistic model. The logistic regression analysis was used to construct the multivariate risk model and nomogram with internal and external validation.Results: There were differential correlations between variable pairs in AFB- IGRA+ TB and PN. We found several significant variables in TB compared with PN. Among them, uric acid (UA) was up-elevated , acting as a protective factor with an odds ratio (OR) < 1. By integrating five variables, including Age, UA, albumin (ALB), hemoglobin (Hb) and white blood cell counts (WBC), we constructed a multivariate risk model with a concordance index (C-index) of 0.7 (95% CI: 0.61, 0.8). Nomogram showed that UA and Hb had the protection effect, while Age, WBC and ALB acted as risk factors on TB occurrence. Internal and external validation revealed a good agreement between nomogran prediction and actual observations.Conclusions: Differential correlations existed between variable pairs in AFB- IGRA+ TB and PN. An integration of five biomarkers (Age, UA, ALB, Hb and WBC) can be used to predict TB in AFB- IGRA+ clinical samples from PN.

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Prevalence of anemia among patients with tuberculosis: A systematic review and meta-analysis

Cited by 33 publications

References 33 publications

Anemia in tuberculosis cases: A biomarker of severity?

Anemia in tuberculosis cases: A biomarker of severity?

Impact of Persistent Anemia on Systemic Inflammation and Tuberculosis Outcomes in Persons Living With HIV

Predictive value of a Five-Biomarker Signature to Diagnose Active Pulmonary Tuberculosis Patients

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