Abstract
Background
This study aimed to analyze the risk factors influencing the unfavorable responses to treatments in rifampicin-sensitive pulmonary tuberculosis (PTB) patients for the early identification of high-risk patients and timely interventions.
Methods
Rifampicin-sensitive PTB patients admitted to the Department of Infectious Diseases, Quzhou Hospital Affiliated to Wenzhou Medical University, between January 1, 2020, and December 31, 2021, were included. Univariable and multivariable logistic regression analyses were used to analyze the relevant risk factors, and the predictive value of these risk factors was assessed using the receiver operating characteristic (ROC) curve.
Results
A total of 731 rifampicin-sensitive PTB patients were included. Multivariable logistic regression analysis showed that male gender (odds ratio [OR] = 2.397, 95% confidence interval [CI] 1.227-4.684), age ≥ 60 years (OR = 3.527, 95% CI 1.675-7.425), concomitant respiratory failure (OR = 3.727, 95% CI 1.163-11.944), elevated C-reactive protein (CRP) (OR = 1.008, 95% CI 1.002-1.013), decreased CD4+/CD8+ ratio (OR = 0.783, 95% CI 0.628-0.976), and low body mass index (BMI) (OR = 0.908, 95% CI 0.829-0.994) were identified as risk factors for failed treatments in rifampicin-sensitive PTB patients (P< 0.05). Male gender (OR = 13.701, 95% CI 1.461-128.481), age ≥ 60 years (OR = 5.684, 95% CI 1.058-30.538), concomitant chronic obstructive pulmonary disease (OR = 3.531, 95% CI 1.163-10.718), hypoalbuminemia (OR = 0.801, 95% CI 0.692-0.928), decreased CD4+/CD8+ ratio (OR = 0.637, 95% CI 0.412-0.984), and low BMI (OR = 0.787, 95% CI 0.643-0.963) were identified as prognostic risk factors for rifampicin-sensitive PTB patients (P < 0.05). The areas under the curve (AUC) for CRP, CD4+/CD8+, and BMI in predicting unfavorable treatment responses were 0.697, 0.576, and 0.632, respectively. The AUCs for serum albumin, CD4+/CD8+, and BMI in predicting mortality in rifampicin-sensitive PTB patients were 0.907, 0.651, and 0.710, respectively.
Conclusion
Male gender, age ≥ 60 years, concomitant respiratory failure and chronic obstructive pulmonary disease, hypoalbuminemia, elevated CRP, decreased CD4+/CD8+ ratio, and low BMI were identified as risk factors for unfavorable treatment responses in rifampicin-sensitive PTB patients. Specifically, serum albumin alone showed the highest prognostic predictive value among rifampicin-sensitive PTB patients.