The prevalence of pulmonary hypertension in post-tuberculosis and active tuberculosis populations: a systematic review and meta-analysis

Abstract

Background:The prevalence of tuberculosis (TB)-associated pulmonary hypertension (PH) has not previously been quantified, resulting in an underappreciated burden of disease. We aimed to estimate the prevalence of PH in post-TB and active TB populations.Methods:In this systematic review and meta-analysis, we searched PubMed/Medline, Cochrane Library, EBSCOhost, Scopus, African Journals Online and Google Scholar, with no language restriction, for available literature published after 1950. Eligible studies described adult participants (≥16 years), with documented evidence of active or prior TB, diagnosed with PH. Study quality was assessed using a risk of bias tool specifically developed for prevalence studies. Aggregate prevalence estimates with 95% confidence intervals were synthesised using a random-effects meta-analysis model, incorporating the Freeman–Tukey transformation. Subgroup analysis was conducted to ascertain prevalence estimates in specific patient populations.Results:We identified 1452 unique records, of which 34 met our inclusion criteria. 23 studies, with an acceptable risk of bias and where PH was diagnosed at right heart catheterisation or echocardiography, were included in the meta-analysis. In post-TB studies (14/23), the prevalence of PH was 67.0% (95% CI 50.8–81.4) in patients with chronic respiratory failure, 42.4% (95% CI 31.3–54.0) in hospitalised or symptomatic patients and 6.3% (95% CI 2.3–11.8) in nonhealthcare-seeking outpatients (I2=96%). There was a lower estimated prevalence of PH in studies of populations with active TB (9.4%, 95% CI 6.3–13.0), I2=84%).Conclusion:Our results highlight the significant burden of PH in post-TB and active TB populations. We emphasise the need for increased recognition of TB-associated PH and additional high-quality prevalence data.

Perspectives from the 2nd International Post-Tuberculosis Symposium: mobilising advocacy and research for improved outcomes

“…Recent estimates for PH post-TB range from 67% in patients with respiratory failure, to 42% for hospitalised patients and symptomatic outpatients, and up to 6% of non-healthcare seeking outpatients. 19 Early data show no associations with spirometry, HIV and 6-minute walk distance, but a possible association with cigarette smoking and multiple episodes of TB. 20 The relationship between parenchymal damage and presence of PH is unclear, with univariate associations not maintaining significance after adjustment for confounders.…”

Pulmonary vascular disease, environmental pollution, and climate change

“…103 The prevalence of PH in post-tuberculosis lung disease is estimated at 48%. 104 More than 200 million people live in places that sea level rise will affect by 2100. 105 Relocation to higher altitudes may expose unacclimatised populations to hypoxia, increasing the risk of high altitude PH.…”