OP93 The effects of diabetes on tuberculosis treatment outcomes: an updated systematic review and meta-analysis
Notice bibliographique
Résumé
Background It has previously been suggested that diabetes worsens tuberculosis treatment outcomes, but studies included in previous systematic reviews had substantial limitations in defining tuberculosis and diabetes, and made little adjustment for potential confounders. Many new studies have been published in this area since 2010. We performed an updated systematic review and meta-analysis. Methods We searched bibliographic databases including MEDLINE/Pubmed, Cochrane CENTRAL, EMBASE, CINAHL, Web of Science, Scopus, and LILACS between January 1st 1980 and July 1st 2015, not restricted by language or region. We included cohort (prospective or retrospective) studies, case-control studies, and randomised controlled trials which investigated the difference in tuberculosis treatment outcomes between patients with both tuberculosis and diabetes and those with tuberculosis only. Study participants were not restricted by sex, race, drug resistance, or HIV status. Tuberculosis treatment outcomes were defined by WHO guidelines. Additional outcomes including relapse and recurrence were also considered. The Newcastle-Ottawa Scale and Cochrane review guidelines were used to assess the methodological quality and risk of bias of the included studies. Two reviewers independently reviewed all titles, abstracts, and extracted data. Random effect meta-analysis using generic inverse variance method was used for data synthesis using Stata 12, and main analyses were stratified by low and high income countries. Results Of 15476 titles identified, 4156 articles were duplicates, and another 11028 studies were excluded after the abstract screening. Full-text screening was performed in 292 articles, of which 100 studies were eligible for inclusion for systematic review (including 70178 tuberculosis only patients and 11562 patients with both tuberculosis and diabetes). Patients with both tuberculosis and diabetes had double the risk of treatment failure or death compared with those with tuberculosis only (Odds ratio = 2.06, 95% CI: 1.68–2.53). Diabetes was also associated with increased risk of recurrence (1.57, 1.38–1.79), but not relapse (1.12, 0.50–2.49). Moreover, the odds ratio for death, and treatment failure were similar in low- (2.08, 1.54–2.82) and high-income countries (2.00, 1.52–2.52). Conclusion Death or treatment failure was twice as common in tuberculosis patients with diabetes, compared with those without; longer-term outcomes such as recurrence were also adversely affected. Diabetes burden is rising globally, particularly in urban centres in low-income countries where tuberculosis is still endemic. Given the high risk of a poor outcome among those with co-morbid disease, heightened clinical attention to improve both diabetes control and tuberculosis outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,021 | 0,053 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,018 | 0,043 |
| Bibliométrie | 0,014 | 0,014 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».