BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau

Anders Solitander Bohlbro; Antonio Matteus Mendes; Armando Sifna; Cecilie Blenstrup Patsche; Martin Emil Schomann Soelberg; Victor Gomes; Christian Wejse; Frauke Rudolf

doi:10.1093/trstmh/trac120

BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau

Anders Solitander Bohlbro^*, Antonio Matteus Mendes, Armando Sifna, Cecilie Blenstrup Patsche, Martin Emil Schomann Soelberg, Victor Gomes, Christian Wejse, Frauke Rudolf

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

BACKGROUND: Growing evidence supports the existence of a sex difference in immunity to tuberculosis (TB). This is most often to the detriment of males. This study aimed to assess the association between scar size from bacillus Calmette-Guérin (BCG) and mortality risk stratified by sex.

METHODS: Kaplan-Meier survivor functions and Cox proportional hazard models were used to assess mortality risk by sex and scar size. Groups were further compared by clinical and epidemiological characteristics.

RESULTS: Between 2003 and 2019, 2944 eligible patients were identified, of whom 1003 were included in the final analysis. Males with BCG scars, particularly large scars, were less likely to die within 1 y of diagnosis than males with no scar (adjusted hazard ratio 0.36 [95% confidence interval 0.15 to 0.88]). In contrast, females with small scars trended towards higher mortality than females with no scars or females with large scars.

CONCLUSIONS: BCG protects against death in male but not female patients with TB. More research is needed to determine the mechanisms underpinning these sex differences and whether they are generalizable beyond this setting.

Originalsprog	Engelsk
Tidsskrift	Transactions of the Royal Society of Tropical Medicine and Hygiene
Vol/bind	117
Nummer	5
Sider (fra-til)	365-374
Antal sider	10
ISSN	0035-9203
DOI	https://doi.org/10.1093/trstmh/trac120
Status	Udgivet - 1 maj 2023

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title = "BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau",

abstract = "BACKGROUND: Growing evidence supports the existence of a sex difference in immunity to tuberculosis (TB). This is most often to the detriment of males. This study aimed to assess the association between scar size from bacillus Calmette-Gu{\'e}rin (BCG) and mortality risk stratified by sex.METHODS: Kaplan-Meier survivor functions and Cox proportional hazard models were used to assess mortality risk by sex and scar size. Groups were further compared by clinical and epidemiological characteristics.RESULTS: Between 2003 and 2019, 2944 eligible patients were identified, of whom 1003 were included in the final analysis. Males with BCG scars, particularly large scars, were less likely to die within 1 y of diagnosis than males with no scar (adjusted hazard ratio 0.36 [95% confidence interval 0.15 to 0.88]). In contrast, females with small scars trended towards higher mortality than females with no scars or females with large scars.CONCLUSIONS: BCG protects against death in male but not female patients with TB. More research is needed to determine the mechanisms underpinning these sex differences and whether they are generalizable beyond this setting.",

keywords = "Bacillus Calmette-Guerin (BCG), immunology, low-resource settings, mortality risk, sex differences, tuberculosis",

author = "Bohlbro, {Anders Solitander} and Mendes, {Antonio Matteus} and Armando Sifna and Patsche, {Cecilie Blenstrup} and Soelberg, {Martin Emil Schomann} and Victor Gomes and Christian Wejse and Frauke Rudolf",

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doi = "10.1093/trstmh/trac120",

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journal = "Transactions of the Royal Society of Tropical Medicine and Hygiene",

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BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau. / Bohlbro, Anders Solitander; Mendes, Antonio Matteus; Sifna, Armando et al.
I: Transactions of the Royal Society of Tropical Medicine and Hygiene, Bind 117, Nr. 5, 01.05.2023, s. 365-374.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau

AU - Bohlbro, Anders Solitander

AU - Mendes, Antonio Matteus

AU - Sifna, Armando

AU - Patsche, Cecilie Blenstrup

AU - Soelberg, Martin Emil Schomann

AU - Gomes, Victor

AU - Wejse, Christian

AU - Rudolf, Frauke

PY - 2023/5/1

Y1 - 2023/5/1

N2 - BACKGROUND: Growing evidence supports the existence of a sex difference in immunity to tuberculosis (TB). This is most often to the detriment of males. This study aimed to assess the association between scar size from bacillus Calmette-Guérin (BCG) and mortality risk stratified by sex.METHODS: Kaplan-Meier survivor functions and Cox proportional hazard models were used to assess mortality risk by sex and scar size. Groups were further compared by clinical and epidemiological characteristics.RESULTS: Between 2003 and 2019, 2944 eligible patients were identified, of whom 1003 were included in the final analysis. Males with BCG scars, particularly large scars, were less likely to die within 1 y of diagnosis than males with no scar (adjusted hazard ratio 0.36 [95% confidence interval 0.15 to 0.88]). In contrast, females with small scars trended towards higher mortality than females with no scars or females with large scars.CONCLUSIONS: BCG protects against death in male but not female patients with TB. More research is needed to determine the mechanisms underpinning these sex differences and whether they are generalizable beyond this setting.

AB - BACKGROUND: Growing evidence supports the existence of a sex difference in immunity to tuberculosis (TB). This is most often to the detriment of males. This study aimed to assess the association between scar size from bacillus Calmette-Guérin (BCG) and mortality risk stratified by sex.METHODS: Kaplan-Meier survivor functions and Cox proportional hazard models were used to assess mortality risk by sex and scar size. Groups were further compared by clinical and epidemiological characteristics.RESULTS: Between 2003 and 2019, 2944 eligible patients were identified, of whom 1003 were included in the final analysis. Males with BCG scars, particularly large scars, were less likely to die within 1 y of diagnosis than males with no scar (adjusted hazard ratio 0.36 [95% confidence interval 0.15 to 0.88]). In contrast, females with small scars trended towards higher mortality than females with no scars or females with large scars.CONCLUSIONS: BCG protects against death in male but not female patients with TB. More research is needed to determine the mechanisms underpinning these sex differences and whether they are generalizable beyond this setting.

KW - Bacillus Calmette-Guerin (BCG)

KW - immunology

KW - low-resource settings

KW - mortality risk

KW - sex differences

KW - tuberculosis

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U2 - 10.1093/trstmh/trac120

DO - 10.1093/trstmh/trac120

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SN - 0035-9203

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JO - Transactions of the Royal Society of Tropical Medicine and Hygiene

JF - Transactions of the Royal Society of Tropical Medicine and Hygiene

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ER -

BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau

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