The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients

Abstract

There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross‐sectional, community‐based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6‐min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years ( SD 13.8 years) and a median of one TB episode (interquartile range: 1–2). Co‐morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35–40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH‐postTB 2.13‐fold (confidence interval [CI]: 1.17–3.88; p = 0.013). All of those found to have PH were smokers or ex‐smokers yielding an unadjusted odds ratio for PH‐postTB of 3.67 (95% CI: 0.77–17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co‐morbidities demonstrated significant association with PH. PH after TB was a common finding in this community‐based population. Further research is needed to confirm and determine the significance of these findings.

The prevalence of pulmonary hypertension in post-tuberculosis and active tuberculosis populations: a systematic review and meta-analysis

“…Sensitivity analysis showed that removing studies with a higher risk of bias resulted in a lower overall prevalence whereas the removal of studies with smokers or HIV participants had little effect on the overall estimates (supplementary material, table S4). In four studies where PH was diagnosed by echocardiography, the mean PASP was reported, yielding a pooled mean PASP of 58.6 mmHg (95% CI 52.8-64.4) in these studies [18,[30][31][32].…”

“…LOUW et al [30] KALLA et al implications that may be related to TB-associated PH, appropriate targeted screening may indeed have long-term cost benefits [4,34].…”

“…The prevalence of PH active TB ranged from 3.0% (95% CI 0.6-8.5) to 18.9% (95% CI 10.8-29.7) (supplementary material, figure S4) with an overall pooled prevalence of 9.4% (95% CI 6.3-13.0) and AHMED et al [57] AKKARA et al [58] AL OBAIDY et al [65] DASTI et al [66] DESALU et al [67] FAWIBE et al [68] JAFRI et al [32] JO et al [18] KALLA et al [50] KANG et al [69] KURIYAMA et al [37] LEE et al [59] LEVINSKY [26] LIU et al [29] LOUW et al [30] MARJANI et al [70] MARESSA et al [71] MKOKO et al [60] MONEGER et al [36] NICOLA et al [61] NIGAM et al [72] NISHIMURA et al [62] OH et al [27] RAJEEV [31] SALAMI et al [28] SASAKI et al [35] SINGH et al [63] SINGHAL et al [64] TIWARI et al [17] TODOROFF et al [73] Acknowledgements: We acknowledge the librarians at the University of Cape Town and Stellenbosch University libraries for their assistance in the retrieval of articles which were not available online. We are grateful to the professional translators at SimplyTranslate and Este van Zyl (independent translator) for the translation of Japanese, Romanian and Korean articles.…”

Perspectives from the 2nd International Post-Tuberculosis Symposium: mobilising advocacy and research for improved outcomes

“… 19 Early data show no associations with spirometry, HIV and 6-minute walk distance, but a possible association with cigarette smoking and multiple episodes of TB. 20 The relationship between parenchymal damage and presence of PH is unclear, with univariate associations not maintaining significance after adjustment for confounders. 21 – 23 However, PH post-TB appears to have higher mortality and hospital readmission rates than PH in other chronic lung diseases.…”

A scoping review of interventions to address TB associated respiratory disability

“… 17 , 18 Prospective data show some recovery of lung function within the first year after TB treatment completion, but a high proportion of individuals experience ongoing symptoms or abnormal spirometry beyond this. 19 Long term respiratory consequences of residual lung pathology amongst TB survivors are heterogenous 8 , 10 , 11 and poorly described, but may include secondary bacterial infections, fungal colonisation and disease, 20 pulmonary hypertension, 21 and increased mortality rates for the minority with more severe lung damage. 22 It is possible that chronic respiratory disease may itself be a risk factor for PTB disease, and the high burden of residual respiratory pathology and impairment observed amongst TB survivors may in part reflect pre-existent, as well as TB-related, lung damage.…”