Tuberculosis-associated anemia is linked to a distinct inflammatory profile that persists after initiation of antitubercular therapy

Abstract

Pulmonary tuberculosis (PTB) is associated with chronic inflammation and anemia. How anemia impacts systemic inflammation in PTB patients undergoing antitubercular therapy (ATT) is not fully understood. In the present study, data on several blood biochemical parameters were retrospectively analyzed from 118 PTB patients during the first 60 days of ATT. Multidimensional statistical analyses were employed to perform detailed inflammatory profiling of patients stratified by anemia status prior to treatment. Anemia was defined as hemoglobin levels <12.5 g/dL for female and <13.5 g/dL for male individuals. The findings revealed that most of anemia cases were likely caused by chronic inflammation. A distinct biosignature related to anemia was detected, defined by increased values of uric acid, C-reactive protein, and erythrocyte sedimentation rate. Importantly, anemic patients sustained increased levels of several biochemical markers at day 60 of therapy. Preliminary analysis failed to demonstrate association between persistent inflammation during ATT with frequency of positive sputum cultures at day 60. Thus, TB patients with anemia exhibit a distinct inflammatory profile, which is only partially reverted at day 60 of ATT.

Impact of Persistent Anemia on Systemic Inflammation and Tuberculosis Outcomes in Persons Living With HIV

“…Our results are in agreement with other previously published findings which demonstrated that lower body mass index (27)(28)(29), higher HIV viral loads (28), and lower CD4 + T-cell counts are all associated with higher prevalence of anemia (25,26). As previously reported by us in a different cohort of TB patients, most of the anemia cases are attributed to chronic inflammation rather than to iron deficiency (10). A recent systematic review demonstrated that anemia is related to an increased risk of all-cause mortality and incident TB among PLWH, regardless of the anemia type (30).…”

“…With regard to the biochemical parameters, our results indicate that low Hb levels accompanied higher values of ALT, AST and GGT, and lower concentrations of albumin. Such findings are similar to those previously published by our group in another cohort of TB patients and reinforce the idea that anemia is related to a distinct biochemical profile and linked to inflammation (10). In our study, the prevalence of hepatitis B or C in anemic patients (9.48%) was very similar to non-anemic patients (10.8%), suggesting that although this comorbidity is present, it is probably not the main factor driving the differences in the levels of liver transaminases.…”

“…Many studies have associated anemia with poor prognosis and increased mortality after TB diagnosis (6,7,9). In patients with TB, anemia has been attributed to be caused by chronic inflammation (10). It has also been shown that anemia is related to accelerated HIV/AIDS disease progression in PLWH (11).…”

Anemia Burden, Types and Associated Risk Factors among Kenyan Human Immunodeficiency Virus-1 and Mycobacterium Tuberculosis Co-infected Injection Substance UsersAnemia Burden, Types and Associated Risk Factors among Kenyan Human Immunodeficiency Virus-1 a

“…Also, HIV-1 infection is associated with low hemoglobin levels (36). Likewise, several recent studies have reported anemia in TB infected patients (34). However, a combination of all these possible anemia etiologies has not been studied in the milieu of Kenyan ISUs.…”

Ефективність Застосування Вітамінотерапії Й Амінокислотного Препарату В Комплексі Лікування Хронічного Обструктивного Захворювання Легень Із Супутньою Анемією Хронічних Захворювань У Пацієнтів, Що Перенесли Туберкульоз Легень

“…Анемія діагностується у 16-30 % пацієнтів із ХОЗЛ і 16-94 % хворих на ТБЛ, що значно більше, ніж у загальній популяції. Згідно з даними літератури, у пацієнтів із ХОЗЛ переважно діагностуються ЗДС, тоді як за умов ТБЛ -АХЗ [3,4].…”