Clinical Factors Associated with Cavitary Tuberculosis and Its Treatment Outcomes.

Sun-Hyung Kim,Kang Hyeon Choe,Jin Young Yoo,Ki Man Lee,Jun Yeun Cho,Bumhee Yang,Hyeran Kang,Yoon Mi Shin,Hyun Lee

doi:10.3390/jpm11111081

Abstract

Cavitary pulmonary tuberculosis (TB) is associated with poor outcomes, treatment recurrence, higher transmission rates, and the development of drug resistance. However, reports on its clinical characteristics, associated factors, and treatment outcomes are lacking. Hence, this study sought to evaluate the clinical factors associated with cavitary pulmonary TB and its treatment outcomes. We retrospectively evaluated 410 patients with drug-susceptible pulmonary TB in a university hospital in Korea between 2014 and 2019. To evaluate the factors associated with cavitary TB, multivariable logistic regression was performed with adjustments for potential confounders. We also compared the treatment outcomes between patients with cavitary TB and those without cavitary TB. Of the 410 patients, 244 (59.5%) had non-cavitary TB and 166 (40.5%) had cavitary TB. Multivariable logistic analysis with forward selection method showed that body mass index (BMI) (adjusted OR = 0.88, 95% CI: 0.81–0.97), previous history of TB (adjusted OR = 3.45, 95% CI: 1.24–9.59), ex- or current smoker (adjusted OR = 1.77, 95% CI: 1.01–3.13), diabetes mellitus (adjusted OR = 2.72, 95% CI: 1.36–5.44), and positive results on the initial sputum acid-fast bacilli (AFB) smear (adjusted OR = 2.24, 95% CI: 1.26–3.98) were significantly associated with cavitary TB. Although treatment duration was significantly longer in patients with cavitary TB than in those with non-cavitary TB (248 (102–370 days) vs. 202 (98–336 days), p < 0.001), the recurrence rate after successful treatment was significantly higher in the patients with cavitary TB than in those with non-cavitary TB (0.4% vs. 3.0% p = 0.042). In conclusion, ex- or current smoker, lower BMI, previous history of TB, diabetes mellitus, and positivity of the initial AFB smear were associated with cavitary TB. The patients with cavitary TB had more AFB culture-positive results at 2 months, longer treatment duration, and higher recurrence rates than those with non-cavitary TB.

Highlights

IntroductionThe proportion of patients with pulmonary tuberculosis (TB) who have a cavitary disease at the time of diagnosis ranges from 29 to 87% [1,2,3]
Univariable analysis showed that age, male sex, body mass index (BMI), previous history of TB, smoking, diabetes mellitus, positive results of initial acid-fast bacilli (AFB) smear
Multivariable analysis showed that BMI, previous history of TB, smoking, diabetes mellitus, and positive results of initial AFB smear were significantly associated with cavitary TB after adjusting for age, sex, BMI, previous history of TB, smoking, comorbidities, initial AFB smear, nucleic acid amplification test (NAAT), and bilateral involvement on chest X-ray (Table 2)

Summary

Introduction

The proportion of patients with pulmonary tuberculosis (TB) who have a cavitary disease at the time of diagnosis ranges from 29 to 87% [1,2,3]. Several studies have reported that the high oxygen concentration inside the cavity facilitates bacterial replication and increases the bacterial loads in the sputum [4,5,6]. Anti-TB drugs cannot penetrate the cavity [7,8], leading to treatment failure or disease recurrence [3,9,10,11,12]. Cavitary disease is associated with high bacterial load, treatment failure, and recurrence

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Discussion

Conclusion