Abstract:

Objective: Explore the clinical characteristics of elderly patients (aged 60 years and above) with pulmonary tuberculosis and malnutrition, as well as to analyze the factors associated with malnutrition and treatment outcomes. Methods: We conducted a multicenter, retrospective cohort study involving a large sample size. A total of 1401 newly diagnosed, drug-sensitive PTB patients aged 60 years or older were consecutively enrolled from November 1, 2020, to April 30, 2024, across four hospitals: Shanghai Pulmonary Hospital, Shandong Public Health Clinical Center, Nanjing Second Hospital (Jiangsu), and Shenyang Tenth People’s Hospital. Patients were categorized into a malnutrition group (study group) and a non-malnutrition group (control group) based on the presence of malnutrition assessed by the GLIM criteria within 24 hours of admission. Comprehensive clinical information was collected for all patients throughout their treatment course. A binary logistic regression model was employed to analyze the factors influencing treatment outcomes in these malnourished patients. Results: The prevalence of malnutrition among elderly drug-sensitive PTB patients was 47.61% (667/1401). In comparison to the non-malnutrition group, which exhibited a cure rate of 50.27% (369/734) and a treatment completion rate of 26.43% (194/734), the malnutrition group demonstrated significantly lower rates of cure (41.68% (278/667)) and treatment completion (21.89% (146/667)). Additionally, the malnutrition group had a markedly higher rate of unfavorable treatment outcomes (36.43% (243/667) vs. 23.30% (171/734)), with all differences being statistically significant (χ²=10.383, P=0.001; χ²=3.922, P=0.048; χ²=28.959, P<0.001). Multivariable logistic regression analysis identified several independent risk factors for treatment outcomes, including aged 70-79 years (OR=1.551, 95%CI: 1.373-1.814), concurrent bacterial pneumonia (OR=1.432, 95%CI: 1.223-1.837), involvement of three or more lung fields (OR=1.565, 95%CI: 1.058-2.316), and adverse drug reactions (OR=1.744, 95%CI: 1.210-2.515). Conclusion: Elderly PTB patients suffering from malnutrition are characterized by a high comorbidity rate, elevated rates of unfavorable outcomes, and low rates of treatment completion and cure. Clinical management should focus on individuals aged 70-79 years, those with concurrent bacterial pneumonia, patients with three or more lung fields affected, and those experiencing adverse drug reactions, in order to improve treatment outcomes of this vulnerable population.

Key words: Tuberculosis, pulmonary, Aged, Malnutrition, Treatment outcome, Prognosis, Factor analysis, statistics