Incidence of systemic vasculitides after Mycobacterium tuberculosis infection: a population-based cohort study in Korea

Abstract

Background: Tuberculosis (TB) is a highly prevalent disease associated with significant morbidity and mortality globally and is reported to be associated with the onset of autoimmunity. This study investigated the association between TB and the incidence of systemic vasculitides (SV).

Methods: Data were obtained from the South Korean National Claims database to identify patients with TB and controls (who had undergone appendectomy). The overall occurrence of SV and disease subtypes during the observation period was compared between the two groups. Adjusted Cox proportional hazards regression and Kaplan-Meier analysis were performed to identify the relationship between TB and SV and to compare SV incidence.

Results: We identified 418 677 patients with TB and 160 289 controls. The overall SV incidence rate was 192/1 000 000 person-years during a mean follow-up of 7.5 years and was higher in patients with TB than controls. Cox regression revealed that the risk of SV was elevated in the TB group independently (adjusted hazard ratio [aHR]: 1.72, 95% confidence interval [CI]: 1.45-2.05). Furthermore, the risk of SV was significantly higher in extrapulmonary TB (aHR: 4.28, 95% CI: 3.52-5.21) when the TB group was categorized into pulmonary and extrapulmonary TB. The findings remained identical even after applying a stabilized inverse probability of treatment weighting analysis.

Conclusions: Patients with TB have an increased risk of SV, which is prominent in extrapulmonary TB. As well as confirming TB is associated with an increased incidence of immune-related vasculitis, our findings highlight the need for clinical vigilance for early diagnosis and initiation of treatment.