Respiratory medicine · 2025
Characteristics and in-hospital outcomes of clinically diagnosed tuberculosis patients in a high-burden setting: A five-year retrospective analysis.
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Autentico Alicia Rose T, Lim Bryan Albert
Аннотация
BACKGROUND: The 2016 National TB Prevalence Survey revealed that TB prevalence was 2.5 times higher than routine surveillance indicated and half of all patients receiving treatment were missing from the national registry. Clinically diagnosed tuberculosis (CD-TB), duly recognized in the national TB guidelines when microbiological confirmation is unattainable, remains understudied despite its relevance in the TB diagnostic and surveillance program.
METHODS: This retrospective study analyzed 1187 hospitalized CD-TB patients (2015-2019) at a Philippine tertiary hospital. Statistical analyses identified mortality predictors via binary logistic regression (p < 0.05 significant).
RESULTS: Patients (mean age 47.2 ± 17.3 years; 70 % male) faced significant resource constraints: only 7.3 % received GeneXpert testing, and 52.7 % of extrapulmonary TB cases lacked required imaging. Advancing age reduced improvement likelihood (OR = 0.9889/year, 95 % CI 0.9815-0.9963, p = 0.003). Pulmonary TB decreased improvement odds by 60 % (OR = 0.40, 95 % CI 0.23-0.68, p < 0.001). Respiratory failure depicts disease severity, with patients on supplemental oxygen (OR = 0.60, 95 % CI 0.40-0.89, p = 0.011) and mechanical ventilation (OR = 0.14, 95 % CI 0.08-0.25, p < 0.001) reduced improvement by 40 % and 86 %, respectively. Conversely, incentive spirometry (OR = 3.59, 95 % CI 1.19-10.86, p = 0.024) and surgical intervention (OR = 3.10, 95 % CI 1.84-5.23, p < 0.001) tripled improvement odds.
CONCLUSION AND RECOMMENDATIONS: Age, pulmonary TB, and respiratory failure predict mortality in hospitalized CD-TB patients. Incentive spirometry and surgery significantly improve outcomes. Findings provide input into the Philippine Acceleration Action Plan for TB (PAAP-TB 2023-2035): scale pulmonary rehabilitation and surgical pathways, address diagnostic gaps (imaging, GeneXpert), and integrate screening into poverty-alleviation programs (DSWD/4Ps).
METHODS: This retrospective study analyzed 1187 hospitalized CD-TB patients (2015-2019) at a Philippine tertiary hospital. Statistical analyses identified mortality predictors via binary logistic regression (p < 0.05 significant).
RESULTS: Patients (mean age 47.2 ± 17.3 years; 70 % male) faced significant resource constraints: only 7.3 % received GeneXpert testing, and 52.7 % of extrapulmonary TB cases lacked required imaging. Advancing age reduced improvement likelihood (OR = 0.9889/year, 95 % CI 0.9815-0.9963, p = 0.003). Pulmonary TB decreased improvement odds by 60 % (OR = 0.40, 95 % CI 0.23-0.68, p < 0.001). Respiratory failure depicts disease severity, with patients on supplemental oxygen (OR = 0.60, 95 % CI 0.40-0.89, p = 0.011) and mechanical ventilation (OR = 0.14, 95 % CI 0.08-0.25, p < 0.001) reduced improvement by 40 % and 86 %, respectively. Conversely, incentive spirometry (OR = 3.59, 95 % CI 1.19-10.86, p = 0.024) and surgical intervention (OR = 3.10, 95 % CI 1.84-5.23, p < 0.001) tripled improvement odds.
CONCLUSION AND RECOMMENDATIONS: Age, pulmonary TB, and respiratory failure predict mortality in hospitalized CD-TB patients. Incentive spirometry and surgery significantly improve outcomes. Findings provide input into the Philippine Acceleration Action Plan for TB (PAAP-TB 2023-2035): scale pulmonary rehabilitation and surgical pathways, address diagnostic gaps (imaging, GeneXpert), and integrate screening into poverty-alleviation programs (DSWD/4Ps).