Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis.
Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis.
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DOI：
10.1016/j.chest.2023.08.021
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发表时间：
2024-01
期刊：
影响因子：
9.6
通讯作者：
Dogar O
中科院分区：
文献类型：
--
作者：
Vidyasagaran AL;Readshaw A;Boeckmann M;Jarde A;Siddiqui F;Marshall AM;Akram J;Golub JE;Siddiqi K;Dogar O
烟草使用与结核病治疗效果不佳之间的关系已有充分的文献记载。然而，对于治疗期间结核病复发或复发和死亡率等重要结局，以及与无烟烟草（ST）的相关性，没有系统地总结证据。烟草使用是否与结核病患者治疗效果不佳的风险相关？于2021年11月22日检索了MEDLINE、Embase和Cumulative Index of Nursing and Allied Health Literature数据库。报告烟草使用与至少一种结核病治疗结果之间相关性的流行病学研究符合条件。进行了独立的双重筛选、提取和质量评估。对两个主要审查结果（治疗期间结核复发或复发和死亡率）进行随机效应荟萃分析，并使用亚组探索异质性。其他结果进行了合成naradically。我们的检索确定了1，249条记录，其中28条被纳入荟萃分析。基于15项研究，发现吸烟者比从不吸烟者结核病复发或复发的风险更高（风险比[RR]，1.78; 95% CI，1.31-2.43; I2 = 85%），目前吸烟vs不吸烟（RR，1.95; 95%CI，1.59-2.40; I2 = 72%），既往吸烟vs从不吸烟（RR，1.84; 95% CI，1.21-2.80; I2 = 4%）;异质性来自研究质量、设计和受试者特征的差异。确定了38项研究的死亡率，其中13项报告了治疗期间的死亡率。曾经吸烟（RR，1.55; 95% CI，1.32-1.81; I2 = 0%）和当前烟草使用（RR，1.51; 95% CI，1.09-2.10; I2 = 87%）与从不使用烟草和目前不使用烟草相比，分别显著增加了结核病患者治疗期间死亡的可能性;异质性在很大程度上是由研究设计的差异解释的。荟萃分析中几乎所有研究的质量评估得分都很高或中等。叙述性综合研究表明，烟草使用是其他不利的结核病治疗结果的一个危险因素，如前所述。关于ST的证据有限，但已确定的研究表明，与不使用ST相比，使用ST会增加不良结局的风险。烟草使用会显著增加结核病患者治疗期间结核病复发或复发的风险以及死亡率，这突出表明需要解决烟草使用问题以改善结核病结局。PROSPERO;编号：CRD42017060821; URL：https://www.crd.york.ac.uk/prospero/
Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. Is tobacco use associated with risk of poor treatment outcomes among people with TB? The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/
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