Risk factors for the adverse course of COVID-19 in patients with tuberculosis

Aim: to elucidate the clinical progression patterns of coronavirus infection (COVID-19) in hospitalized patients with tuberculosis (TB) and to identify predictors of adverse (fatal) outcomes of the disease. Materials and Methods: a retrospective analysis was conducted on the clinical progression of COVID-19, encompassing 178 patients in total. This cohort included 80 patients diagnosed with COVID-19 monoinfection and 98 patients with co-infection (COVID-19 and TB), all hospitalized for COVID-19 treatment between January 2021 and December 2022. Results: patients with concurrent COVID-19 and TB were admitted to hospital at earlier stages of COVID-19. Consequently, this group presented with milder disease severity and lacked significant clinical symptoms upon admission. Despite this, the co-infected group exhibited a greater risk of adverse outcomes. Initial laboratory evaluations for this cohort, conducted at the earliest stage of COVID-19, indicated an active immune response to bacterial infection, as evidenced by increased neutrophil counts, reduced lymphocyte levels, and elevated erythrocyte sedimentation rate (ESR). This profile deteriorated with disease progression, exacerbated by added markers of systemic inflammation. Adverse outcomes for both COVID-19 monoinfection and COVID-19/TB co-infected patients were significantly influenced by advanced age and comorbidities. In patients without TB, chronic hepatitis and renal failure posed the greatest risk, whereas cardiovascular disorders were predominant predictors in those with TB. Additionally, indicators of respiratory distress at the time of hospitalization were significant adverse outcome predictors in both cohorts: dyspnea was a critical factor in patients with COVID-19 alone, whereas blood oxygen saturation (SpO2 levels) was particularly predictive in the COVID-19/TB group. Conclusions: the presence of pulmonary TB exacerbates the clinical course of COVID-19. Early detection of SARS-CoV-2 in patients with TB during hospital admission could play a crucial role in preventing a more severe progression of COVID-19 in this demographic. KEYWORDS: COVID-19, tuberculosis, COVID-19/TB, course severity, predictors of adverse (fatal) outcome. FOR CITATION: Urushadze N.D., Pshenichnaya N.Yu., Parolina L.E., Burykhin V.S., Skornyakov S.N., Vasilyeva I.A. Risk factors for the adverse course of COVID-19 in patients with tuberculosis. Russian Medical Inquiry. 2024;8(11):603–611 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-11-1