Abstract
Background: Lipids play a central role in the pathogenesis of tuberculosis (TB). The effect of serum lipid levels on TB treatment (ATT) outcomes and their association with serum inflammatory markers have not yet been characterized.Methods: Our retrospective cohort study on drug-susceptible TB patients, at the National Taiwan University Hospital, assessed the association of baseline serum lipid levels such as low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC) and triglycerides (TG) with all-cause and infection-related mortality during first 9 months of ATT and baseline inflammatory markers namely C-reactive protein (CRP), total leukocyte count (WBC), and neutrophil-lymphocyte ratio (NL ratio).Results: Among 514 patients, 129 (26.6%) died due to any-cause and 72 (14.0%) died of infection. Multivariable Cox-regression showed a lower adjusted hazard ratio (aHR) of all-cause mortality in the 3rd tertiles of HDL (aHR 0.17, 95% CI 0.07–0.44) and TC (aHR 0.30, 95% CI 0.14-0.65), and lower infection-related mortality in the 3rd tertile of HDL (aHR 0.30, 95% CI 0.14–0.65) and TC (aHR 0.30, 95% CI 0.14–0.65) compared to the 1st tertile. The 3rd tertiles of LDL and TG showed no association in multivariable analysis. Similarly, 3rd tertiles of HDL and TC had lower levels of baseline inflammatory markers such as CRP, WBC, and NL ratio using linear regression analysis. Body mass index (BMI) did not show evidence of confounding or effect modification.Conclusions: Higher baseline serum cholesterol levels were associated with lower hazards of all-cause and infection-related mortality and lower levels of inflammatory markers in TB patients. BMI did not modify or confound this association.
Highlights
Tuberculosis (TB) is an infectious disease with a high morbidity and mortality [1]
The linear regression model demonstrated that higher levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol (TC) were independently associated with lower levels of inflammatory markers such as C-reactive protein (CRP), total leucocyte count (WBC), and NL ratio
We found that the highest tertiles of serum LDL, HDL and TC levels were associated with lower hazards of mortality in the first 9 months of anti-tuberculosis treatment (ATT)
Summary
Tuberculosis (TB) is an infectious disease with a high morbidity and mortality [1]. Patients with TB have an increased incidence of cardiovascular [2] and cerebrovascular disease [3]. The effect of serum lipid levels on anti-tuberculosis treatment (ATT) outcomes is not yet characterized. Sputum smear positivity for Mycobacterium tuberculosis (Mtb) was associated with lower serum levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol (TC) [7]. Lower levels of LDL, HDL and TC correlated with more radiologically extensive TB disease in the lungs [7, 8]. This pattern holds true for the association between lipid levels and community-acquired pneumonia [7]. Whether inflammation plays an important role in the association between lipid levels and TB outcomes is unclear. The effect of serum lipid levels on TB treatment (ATT) outcomes and their association with serum inflammatory markers have not yet been characterized
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