P152 Increase in weight during TB treatment: 3 year survey

• Published in: Thorax Vol. 77; no. Suppl 1; p. A164
• Main Authors: Brij, SO, Noonan, R, Gorsuch, T
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 11.11.2022; BMJ Publishing Group LTD
• Subjects: Tuberculosis; ‘Die Hard II’ – Antibiotic resistance and challenges in TB
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2022-BTSabstracts.287

BackgroundWeight loss is a cardinal symptom of tuberculosis (TB) and routine monitoring of weight is undertaken in TB Clinic. However, the magnitude of weight gain and in which patients this occurs is not well understood.MethodologyAdults diagnosed with TB between January 2019 and December 2021 were retrospectively evaluated with regard to weight gain. In this survey, all patients had good compliance, were adherent with treatment regimens and regularly attended clinic (even during the COVID pandemic).Results181 patients (median age 39 years (IQR 30–51); male 60%; UK born 168%) were identified with TB disease and in whom weight at start, 2 months and end of treatment were documented.The commonest primary sites were pulmonary (28%), extrathoracic (neck) lymphadenopathy (25%), intrathoracic (mediastinal) lymphadenopathy (22%), eye (14%) and pleural (8%) involvement. Smear and culture positivity for pulmonary disease 56 and 84% respectively; non-pulmonary disease 39% (table 1A).All persons completed intended duration TB therapy. Overall, there was a significant increase in weight (defined as >5% weight gain) over the course of treatment (p<0.001) (table 1B). However, half of the patients did not significantly gain weight. The magnitude of weight increase was greatest in pulmonary and pleural disease with nearly half of patients gaining >10% initial weight (see table 1C). Concomitant corticosteroid usage, whether for TB severity or other underlying condition (eye inflammation for example) was also associated with >10% weight gain (RR 1.9; CI 1.2–3.0; p<0.005) and is likely to be a confounding variable.Abstract P152 Table 1TB disease characteristics and pattern of weight gain by primary TB site A. Characteristics of tuberculous disease Primary TB site, n (%)PulmonaryPleuralExtrathoracic (neck) lymphadenopathyIntrathoracic (mediastinal) lymphadenopathyEye disease 50 (27.6)15 (8.3)45 (24.9)22 (12.2)26 (14.4) Treatment duration, n (%)6 months9 months≥ 12 months 139 (76.8)26 (14.4)16 (8.8) Organism identification, n (%)Sputum smear positive aSputum culture positive aNon-pulmonary culture positive b 28 (56)42 (84)51 (38.9) Resistance, n (%) c PyrazinamdeIsoniazidRifampicinMDR (Isoniazid and Rifampicin) 4 (3.9)4 (3.9)1 (0.1)0 aout of 50 patients with pulmonary TBb out of 131 patietns with non-pulmonary TBc out of 93 patients with culture positive TB B. Weight at start, 2 months and end of treatment (mean ±SEM) start of treatment 2 months end of treatment weight, kg 68.4 ± 1.2 70.0 ± 1.2d 73.0 ± 1.1de weight change, kg - 1.6 ± 0.2 4.5 ± 0.4 weight change,% - 2.8 ± 0.4 7.5 ± 0.7 d p<0.001 compared to baseline (repeated measure ANOVA)e p<0.001 compared to 2 months of treatment (repeated measure ANOVA) C. Net weight gain by Primary TB site Primary TB site no weight change, n (%) ≥5% gain, n (%) ≥10% gain, n (%) Pulmonary (50)Pleural (15)Neck (45)Mediastinal (22)Eye (26) 17 (43)6 (40)27 (60)13 (59)22 (85) 33 (66)f 9 (60)f18 (40)8 (36)3 (12) 24 (48)7 (47)6 (13)4 (18)1 (5) ALL 92 (50.8) 87 (48.0) 50 (27.6) fp<0.001 compared to baseline (repeated measure ANOVA)ConclusionIt is not a foregone conclusion that there will be a significant weight increase following successful treatment of TB. However, weight increase in pulmonary and pleural disease should be expected. Further investigation and univariate analysis is required to look for predictors of weight gain at the end of treatment.Weight monitoring is a cheap and easy-to-undertake biological marker. It is essential that there are clinical processes ensuring routine weights are undertaken and recorded.