Influence of COVID‐19 in patients with concurrent tuberculosis coinfections
Influence of COVID‐19 in patients with concurrent tuberculosis coinfections
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COVID-19 对并发结核病合并感染患者的影响
DOI：
10.1002/jmv.26801
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发表时间：
2021
影响因子：
12.7
通讯作者：
Longxiang Xie
中科院分区：
文献类型：
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作者：
Guoying Wang;Linghao Cai;Dandan Chen;Tieshan Teng;Qiming Li;Longxiang Xie
致编辑，我们饶有兴趣地阅读了 Sarkar 等人最近撰写的综述和荟萃分析，其中系统地评估了 COVID-19 对并发感染（包括结核病 (TB)、流感、HIV、慢性肝炎和登革热）患者的影响。作者得出的结论是，结核病患者在同时感染严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 期间死亡风险增加，而艾滋病毒和慢性肝炎患者没有发现显着影响。尽管我们感谢进行全面数据分析的作者，但我们认为有必要对这些发现进行进一步讨论。首先，作者将搜索范围限制在 PubMed、Medline、Embase、Google Scholar 和 MedRxiv，但没有探索其他具有广泛学科领域的国际数据库，包括 Cochrane Library、ClinicalTrials.gov 和其他大型预印本平台（如 bioRxiv）。选择有限的数据库子集进行文献检索可能会导致有偏差的结果。其次，在关于结核病对COVID-19患者死亡率影响的荟萃分析研究中，我们认为Chen等人的研究不能纳入汇总结果，因为结核病组的死亡事件数（n = 1）不准确，应该更多。仔细检查原始信息后，我们发现在并发结核病合并感染的COVID-19患者（年龄≥65岁）中，只有1例死亡事件，但对于并发结核病合并感染的患者（年龄<65岁），没有显示详细的死亡事件。因此，这项研究不能纳入荟萃分析。另外，我们发现图3的数据有错误，需要更正。在Davies等人的研究中，对照组（无结核病的COVID-19患者）的患者总数为20180人，而不是20280人。因此，我们使用R软件对三篇文章（包括Davies等人、Du等人和Therese等人）进行了荟萃分析，修订后的结果如图1所示。三篇文章共23,017名患者评估了死亡率。值得注意的是，与对照组相比，合并感染 COVID-19 的结核病患者的死亡风险增加（风险比 [RR] = 2.09；95% 置信区间 [CI]，1.75–2.51；I = 0%）（图 1）。最后，研究表明，与年轻患者相比，老年 COVID-19 患者初始合并症更多、症状更严重、死亡率更高。因此，应该考虑年龄才能得出明确的结论。因此，最好根据荟萃分析中包含的研究数据进行年龄方面的亚组分析。而且，艾滋病毒、慢性肝炎、流感等都属于病毒感染性疾病。我们认为读者会有兴趣了解病毒感染对 COVID-19 患者死亡率的影响。因此，我们计算了病毒感染的合并RR。未发现与之相关的显着风险增加（RR = 1.37；95% CI，0.66–2.84；I = 98%）（图 2）。总体而言，作者分析了有关 COVID-19 对并发合并感染患者的影响的一个有价值的问题。但仍需要大量样本研究来进一步验证上述结果。
To the Editor, With great interest, we read the recent review and meta‐analyses written by Sarkar et al., which systematically assessed the consequence of COVID‐19 in patients with concurrent infections, including tuberculosis (TB), influenza, HIV, chronic hepatitis, and dengue. The authors concluded that TB patients show an increased risk of mortality during coinfection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), while there is no significant impact found in patients living with HIV and chronic hepatitis. Although we appreciate the authors who performed comprehensive data analysis, we believe that further discussion on these findings is warranted. First, the authors limited their search to PubMed, Medline, Embase, Google Scholar, and MedRxiv, but did not explore other international databases with broad subject areas, including Cochrane Library, ClinicalTrials.gov, and other large preprint platforms such as bioRxiv. The selection of a restricted subset of databases for performing the literature search may cause biased results. Second, in the meta‐analysis study about the influence of TB on mortality in COVID‐19 patients, we think Chen et al.'s study cannot be included in the pooled result because the number of death event (n = 1) in the TB group is not accurate and should be more. After carefully checking the original information, we found that among COVID‐19 patients (age ≥ 65 years) with concurrent TB coinfections, there was only one death event, but for patients (age < 65 years) with concurrent TB coinfections, the detailed death events were not shown. Hence, this study cannot be incorporated into the meta‐analyses. In addition, we found an error in the data of Fig. 3, which needs to be corrected. In the Davies et al.'s study, the total number of patients in control group (COVID‐19 patients without TB) is 20180 rather than 20280. Therefore, we performed a meta‐analysis of three articles (including Davies et al., Du et al., and Therese et al.) using R software and the revised results are shown in Figure 1. Mortality was evaluated in three articles with a total of 23,017 patients. Significantly, increased risk of mortality is observed in TB patients coinfected with COVID‐19 in comparison with the control group (risk ratio [RR] = 2.09; 95% confidence interval [CI], 1.75–2.51; I = 0%) (Figure 1). Finally, studies had shown that the older COVID‐19 patients have greater initial comorbidities, more severe symptoms, and higher mortality rate as compared with younger patients. Thus, the age should be taken into consideration to draw a firm conclusion. Therefore, it will better to perform a subgroup analysis in terms of age, based on the data of the studies included in the meta‐analysis. Moreover, HIV, chronic hepatitis, and influenza all belonged to the virus infection disease. We think readers will be interested in knowing the impact of virus infection on mortality in COVID‐19 patients. Hence, we calculated the merged RR of virus infection. No significant augmented risk is found to be associated with it (RR = 1.37; 95% CI, 0.66–2.84; I = 98%) (Figure 2). Overall, the authors analyzed a valuable issue regarding the impact of COVID‐19 in patients with concurrent coinfections. However, extensive sample studies are still needed to further verify the results mentioned.
DOI：
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发表时间：
2011
期刊：
--
影响因子：
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作者：
J. Higgins
通讯作者：
J. Higgins