The risk factors for severe evolution of SARS-CoV-2 infection in association with pulmonary tuberculosis

Between 2020-2023, the infrastructure of Moldovan medical facilities was adapted to SARS-CoV-2 epidemics and the Municipal Hospital of Pneumophtisiology (MHP) was specialized in clinical-management of COVID-19 and pulmonary TB cases. <bold>Aim:</bold> to assess the risk factors (RF) for severe COVID-19 infection in pulmonary TB patients. <bold>Material and methods:</bold> a case-control, prospective study on 70 TB cases with severe COVID-19 pneumonia hospitalized in RM during 2020-2023 in study group (SG) were compared with 229 TB cases with mild/moderate COVID-19 in control group (CG). Severity criteria for SG were: t>39C, SaO2<93%, respiratory rate>30/min and extensiveness of lung injury on CT >50% of lung surface. <bold>Results:</bold> fever, headaches, profuse sweating, asthenia, loss of smell/taste, insomnia and COVID-19 were confirmed through PCR in 100% cases of both groups. Positive AFB in 117(39%) and Xpert MTB/RIF in 149(50%) in SG vs. 78(34%) and 139(61%) in CG. RF for severe evolution of COVID-19 in TB cases were: male sex (OR=12, CI95% 6.5-11.7), age>50 y.o. (OR=4,2 CI95% 2.4-7.2), recently returning from abroad (OR=2.6, CI95% 1.7-8.9), co-morbid state (OR=42 CI95% 5.8-31), of which Arter. Hypertens. 48(68%) vs. 113(49%), HIV-infection 19(27%) vs. 51(22%), diabetes 10(14%) vs.3(1%), tobacco smoking 69 (98%) vs. 157(68%), alcohol abuse 37(53%) vs. 54(23%), neurological impaired state 44(63%) vs. 38 (17%). Lab exams: PCR>10 mg/dL (OR=5.5 CI95% 2.3-13.3), D-dimer >20μ/mL (OR=364 CI90% 48-2755), lymphopenia (OR=3.7 CI95% 2.1-6.7), LDH>200UI/L (OR=2.2, CI95%1.4-3.7). <bold>Conclusions:</bold> RF for severe COVID-19 infection in TB cases were comorbidities, male sex, age>50 y.o.,increased PCR, D-dimers and lymphopenia.