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SEVERE PULMONARY RADIOLOGICAL MANIFESTATIONS ARE ASSOCIATED WITH A DISTINCT BIOCHEMICAL PROFILE IN BLOOD OF TUBERCULOSIS PATIENTS WITH DYSGLYCEMIA
Hiperglicemia
Diabetes mellitus
Pré-diabetes
Tuberculose pulmonar
Author
Affilliation
Socios En Salud Sucursal Peru. Lima, Peru / Universidad Nacional Mayor de San Marcos. Lima, Peru.
Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Fundação José Silveira. Instituto Brasileiro para Investigação da Tuberculose. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil.
Socios En Salud Sucursal Peru. Lima, Peru.
Socios En Salud Sucursal Peru. Lima, Peru / Universidad Nacional Mayor de San Marcos. Lima, Peru / Harvard Medical School. Brigham and Women’s Hospital. Division of Rheumatology, Inflammation, and Immunity. Boston, MA, USA.
Socios En Salud Sucursal Peru. Lima, Peru.
Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Salvador. Salvador, BA, Brasil.
Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Salvador. Salvador, BA, Brasil.
Socios En Salud Sucursal Peru. Lima, Peru
Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Fundação José Silveira. Instituto Brasileiro para Investigação da Tuberculose. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Salvador. Salvador, BA, Brasil / Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brasil.
Socios En Salud Sucursal Peru. Lima, Peru / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Rio de Janeiro, RJ, Brasil.
Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Fundação José Silveira. Instituto Brasileiro para Investigação da Tuberculose. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil.
Socios En Salud Sucursal Peru. Lima, Peru.
Socios En Salud Sucursal Peru. Lima, Peru / Universidad Nacional Mayor de San Marcos. Lima, Peru / Harvard Medical School. Brigham and Women’s Hospital. Division of Rheumatology, Inflammation, and Immunity. Boston, MA, USA.
Socios En Salud Sucursal Peru. Lima, Peru.
Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Salvador. Salvador, BA, Brasil.
Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Salvador. Salvador, BA, Brasil.
Socios En Salud Sucursal Peru. Lima, Peru
Universidade Federal da Bahia. Faculdade de Medicina. Salvador, BA, Brasil / Fundação José Silveira. Instituto Brasileiro para Investigação da Tuberculose. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Universidade Salvador. Salvador, BA, Brasil / Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil / Faculdade de Tecnologia e Ciências. Curso de Medicina. Salvador, BA, Brasil.
Socios En Salud Sucursal Peru. Lima, Peru / Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Rio de Janeiro, RJ, Brasil.
Abstract
Diabetes mellitus (DM) is thought to affect tuberculosis (TB) clinical presentation and treatment response. Whether DM impacts radiological manifestations of pulmonary TB is still not clear. This study investigated the impact of glycemic status on radiological manifestations of pulmonary TB cases and its relationship with concentration of biochemical parameters in peripheral blood. Methods: A retrospective cross-sectional study used data from 132 microbiologically confirmed pulmonary TB patients
from Lima, Peru, evaluated in a previous investigation performed between February and December 2017. Chest
radiographs were analyzed by a radiologist and a pulmonologist. Radiographic lesions were identified as cavities,
alveolar infiltrates and fibrous tracts. Hyperglycemia in TB patients was identified by use of fasting plasma glucose,
HbA1c and oral glucose tolerance test. Clinical, biochemical and hematological parameters were also analyzed.
Results: TB patients with hyperglycemia presented more frequently with cavities, alveolar infiltrates and fibrous tracts
than those with normoglycemia. Hierarchical clustering analysis indicated that patients with more diverse and higher
number of lung lesions exhibited a distinct laboratorial profile characterized by heightened white blood cell counts
and circulating levels of total cholesterol, triglycerides and transaminases and simultaneously low levels of albumin and
hemoglobin. Multivariable regression analyses adjusted for age, sex, prior TB, hemoglobin levels and acid-fast bacilli
≥2+ in sputum smears, demonstrated that presence of prediabetes or diabetes in TB patients was associated with
increased odds of having 3 pulmonary lesion types (p = 0.003 and p < 0.01 respectively) or ≥ 4 lesions (p = 0.001 and
p = 0.01 respectively).
Conclusion: Hyperglycemia (both DM and prediabetes) significantly affected the presentation of radiographic
manifestations and the number of lesions in pulmonary TB patients as well as the biochemical profile in peripheral blood.
Keywords in Portuguese
Radiografia de tóraxHiperglicemia
Diabetes mellitus
Pré-diabetes
Tuberculose pulmonar
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