Research report: Burden of tuberculosis disease in patients with liver cirrhosis: a systematic review and meta-analysis

A systematic review and meta-analysis estimated that the pooled proportion of tuberculosis disease among patients with liver cirrhosis was 4,000 cases per 100,000 people, with a 95% confidence interval of 3,000 to 5,000. The estimate was based on seven observational epidemiological studies encompassing 72,039 patients with cirrhosis. Published as an accepted pre-publication version in BMC Infectious Diseases , the study characterized the burden as substantially elevated compared with the general population, although the supplied results do not provide a numerical general-population estimate for that comparison.

Cirrhosis is associated with immune dysfunction that includes impaired cell-mediated immunity, complement deficiency and dysfunction of gut-associated lymphoid tissue. The authors report that these abnormalities can increase susceptibility to both primary tuberculosis infection and reactivation of latent tuberculosis disease. TB-endemic settings and alcohol-related cirrhosis are also identified as contexts in which the clinical effects of the two conditions may compound one another, although the results do not report a separate pooled estimate for people with alcohol-related cirrhosis.

To assemble the evidence, the investigators searched Embase, PubMed, Web of Science, Scopus, ScienceDirect, Hinari and Google Scholar for English-language observational epidemiological studies published between January 1, 2000, and June 15, 2025. The search identified 960 articles. Two authors screened studies, extracted data and assessed methodological quality using the Joanna Briggs Institute appraisal tool.

Seven studies with a combined population of 72,039 patients met the inclusion criteria. Statistical analyses were performed in STATA version 16, with a Freeman–Tukey double-arcsine transformation applied to stabilize variance and normalize the reported proportions. The researchers conducted subgroup analyses to examine potential sources of heterogeneity and used a leave-one-out sensitivity analysis to assess the robustness of the pooled estimate.

The highest regional pooled proportion was reported for South Asia: 4,000 tuberculosis disease cases per 100,000 patients with cirrhosis, with a 95% confidence interval of 2,000 to 7,000. The interval indicates substantial uncertainty around that estimate. Across the overall analysis, heterogeneity was considerable, with an I² value of 99.2% and P less than 0.001.

It persisted across nearly all subgroups, where I² values ranged from 94.7% to 99.8%. The supplied results do not establish which specific study characteristics produced this variation. Because all seven included studies were observational, the pooled result estimates the occurrence of tuberculosis disease among patients with cirrhosis and does not demonstrate that cirrhosis causes tuberculosis.

The analysis also does not test the effectiveness of a particular screening, prevention or treatment strategy. Instead, it documents a substantial measured burden and demographic and clinical disparities in risk. The authors concluded that the findings support heightened clinical vigilance for tuberculosis in people with liver cirrhosis and highlight the need for standardized screening protocols, informed by further prospective research.

The open-access article appeared on September 10, 2026, as an accepted version subject to further edits before the final version of record replaces it.

Subject of Research: Pooled tuberculosis disease burden among patients with liver cirrhosis

Article Title: Burden of tuberculosis disease in patients with liver cirrhosis: a systematic review and meta-analysis

Article References: Woldegeorgis, B. Z., Ekubazgi, K. W., & Urgesa, E. A. (2026). Burden of tuberculosis disease in patients with liver cirrhosis: a systematic review and meta-analysis. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14381-5

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14381-5

Keywords: tuberculosis, liver cirrhosis, systematic review, meta-analysis, disease burden, observational studies, South Asia, immune dysfunction, clinical vigilance, Burden, disease, patients