Risk of Aortic Aneurysm and Dissection in Patients with Tuberculosis: A Nationwide Population-Based Cohort Study.

Ming-Tsung Chen,Wu-Chien Chien,Chung-Kan Peng,Chih-Hao Shen,Chi-Hsiang Chung,Hung-Yen Ke

doi:10.3390/ijerph182111075

Abstract

Tuberculosis (TB) can cause chronic inflammation. The occurrence of aortic aneurysm (AA) and aortic dissection (AD) may be associated with chronic inflammatory disease, but whether TB increases the risk of AA and AD remains to be determined. This study aimed to investigate the association between TB and the development of AA and AD. We conducted a population-based cohort study using data obtained from the Taiwan National Health Insurance Database. We selected 31,220 individuals with TB and 62,440 individuals without TB by matching the cohorts according to age, sex, and index year at a ratio of 1:2. Cox regression analysis revealed that the TB cohort had a 1.711-fold higher risk of AA and AD than the non-TB cohort after adjustment for sex, age, socioeconomic status, and comorbidities (adjusted hazard ratio = 1.711; 95% confidence interval = 1.098–2.666). Patients with pulmonary, extrapulmonary, and miliary TB had a 1.561-, 1.892-, and 8.334-fold higher risk of AA and AD, respectively. Furthermore, patients with TB at <6 months, 6–12 months, and 1–5 years of follow-up had a 6.896-, 2.671-, and 2.371-fold risk of AA and AD, respectively. Physicians should consider the subsequent development of AA and AD while treating patients with TB.

Highlights

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, is one of the major causes of death worldwide
PYs = person-years, aHR = adjusted hazard ratio: adjusted for the variables listed in Table 2, CI = confidence interval, incidence rate ratios (IRR) = incidence rate ratio, TB = tuberculosis. This is the first nationwide, population-based cohort study to investigate the risk of Aortic aneurysm (AA) and aortic dissection (AD) in patients with TB by subgroup analyses
The overall finding was that patients with TB, overwhelmingly, have an increased risk and incidence of AA and AD

Summary

Introduction

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, is one of the major causes of death worldwide. In Taiwan, the incidence of TB was 37 cases per 100,000 people and that of TB-related deaths was 2.3 per. 100,000 people in 2019 [2]. TB that affects other organs, such as the lymph nodes, pleura, gastrointestinal tract, bones, urogenital tract, and central nervous system, is known as extrapulmonary TB and accounts for 20–25% of all TB cases [4]. Aortic aneurysm (AA) is the permanent dilation of the aorta and most commonly occurs in the infrarenal and proximal thoracic aortic regions. Most AAs are asymptomatic, but progressive enlargement of the aneurysm increases the risk of dissection and rupture [5]

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