The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis.
The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis.
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DOI：
10.1038/s41598-021-94590-x
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发表时间：
2021-07-27
影响因子：
4.6
通讯作者：
Karakousis PC
中科院分区：
文献类型：
--
作者：
Chidambaram V;Ruelas Castillo J;Kumar A;Wei J;Wang S;Majella MG;Gupte A;Wang JY;Karakousis PC
结核病（TB）和动脉粥样硬化性心血管疾病（ASCVD）在流行病学和发病机制上有密切的重叠。因此，了解ASCVD和TB结果之间的关系变得至关重要。我们对国立台湾大学医院的药物敏感性结核病患者进行回顾性队列研究，评估了既存ASCVD（冠状动脉疾病（CAD）和动脉粥样硬化血栓性卒中（ATS））与9个月全因和感染相关死亡率的相关性，以及全身炎症标志物的介导程度。我们确定了既存ASCVD对2个月痰微生物状态的影响。在ASCVD患者中，我们评估了他汀类药物使用与死亡率的关系。有急性心肌梗死病史的CAD患者9个月全因死亡率较高（CAD+AMI+）（校正HR 2.01，95%CI 1.38-3.00）和ATS患者（aHR 2.79，95%CI 1.92-4.07），同样，CAD+AMI+AMI组感染相关死亡率较高，校正混杂因素后，aHR 1.95，95%CI 1.17-3.24）和ATS（aHR 2.04，95%CI 1.19-3.46）。在2个月时，既存CAD（AMI-或AMI+）或ATS未改变痰培养转化或痰涂片AFB阳性。在多变量线性回归分析中，CAD+AMI+组在TB诊断时的CRP水平显著更高（校正B（SE）1.24（0.62））。CRP分别介导了66%（P = 0.048）和25%（P = 0.033）与CAD+AMI−和CAD+AMI+相关的全因死亡率。总之，ASCVD患者9个月全因和感染相关死亡率的风险较高，在调整混杂因素后，血清炎症升高介导了1 - 3/4的这种相关性。他汀类药物的使用与ASCVD患者的全因死亡率降低相关。
Tuberculosis (TB) and atherosclerotic cardiovascular disease (ASCVD) have a close epidemiological and pathogenetic overlap. Thus, it becomes essential to understand the relationship between ASCVD and TB outcomes. From our retrospective cohort on drug-susceptible TB patients at the National Taiwan University Hospital, we assessed the association of pre-existing ASCVD (coronary artery disease (CAD) and atherothrombotic stroke (ATS)) with 9-month all-cause and infection-related mortality and the extent of mediation by systemic inflammatory markers. We determined the effect of pre-existing ASCVD on 2-month sputum microbiological status. Among ASCVD patients, we assessed the association of statin use on mortality. Nine-month all-cause mortality was higher in CAD patients with prior acute myocardial infarction (CAD+AMI+) (adjusted HR 2.01, 95%CI 1.38–3.00) and ATS patients (aHR 2.79, 95%CI 1.92–4.07) and similarly, for infection-related mortality was higher in CAD+AMI+ (aHR 1.95, 95%CI 1.17–3.24) and ATS (aHR 2.04, 95%CI 1.19–3.46) after adjusting for confounding factors. Pre-existing CAD (AMI- or AMI+) or ATS did not change sputum culture conversion or sputum smear AFB positivity at 2 months. The CAD+AMI+ group had significantly higher levels of CRP at TB diagnosis in the multivariable linear regression analysis (Adjusted B(SE) 1.24(0.62)). CRP mediated 66% (P = 0.048) and 25% (P = 0.033) of the association all-cause mortality with CAD+AMI− and CAD+AMI+, respectively. In summary, patients with ASCVD have higher hazards of 9-month all-cause and infection-related mortality, with elevated serum inflammation mediating one to three-quarters of this association when adjusted for confounders. Statin use was associated with lower all-cause mortality among patients with ASCVD.
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影响因子：
6.5
作者：
Bruiners N;Dutta NK;Guerrini V;Salamon H;Yamaguchi KD;Karakousis PC;Gennaro ML
通讯作者：
Gennaro ML
影响因子：
6
作者：
Antonov, AS;Kolodgie, FD;Gerrity, RG
通讯作者：
Gerrity, RG
影响因子：
5.2
作者：
Del Carmen Guerra-De-Blas, Paola;Bobadilla-Del-Valle, Miriam;Sifuentes-Osornio, Jose
通讯作者：
Sifuentes-Osornio, Jose
影响因子：
9.6
作者：
KINARE, SG;BHATIA, BI
通讯作者：
BHATIA, BI
影响因子：
11.8
作者：
Chidambaram, Vignesh;Gupte, Akshay;Karakousis, Petros C.
通讯作者：
Karakousis, Petros C.