Risk Factors for Disseminated Tuberculosis and Associated Survival in Adults Without Human Immunodeficiency Virus

Abstract

Background: The global resurgence of disseminated tuberculosis (TB) after the coronavirus disease 2019 pandemic highlights the necessity of understanding host risk factors, especially in adults without human immunodeficiency virus. Methods: We reviewed TB cases admitted to Shanghai Public Health Clinical Center from 2017 to 2022. We analyzed baseline characteristics and outcomes. To identify risk factors for disseminated TB, as well as its subsite distribution and mortality, we employed logistic regression and Cox proportional hazards models. Results: Among 1062 patients, including 283 with disseminated TB, 558 with pulmonary TB (PTB), and 221 with extrapulmonary TB, those with disseminated TB had the highest mortality rate. The following factors were associated with disseminated TB: age ≥45 years, body mass index (BMI) <18.5 kg/m², immunosuppressive therapy, and end-stage renal disease (ESRD). A BMI <18.5 kg/m² was found to correlate with all subsites of disseminated TB, while aged ≥45 years specifically increased incidence of bone and joint TB. Female patients showed a higher risk for lymphatic, peritoneal, and intestinal TB. Additionally, immunosuppressive therapy and ESRD were linked to various TB subsites. During a 12-month follow-up period, 19.8% of patients with disseminated TB died. Factors contributing to reduced survival included BMI <18.5 kg/m², immunosuppressive therapy, ESRD, pulmonary cavities, and meningeal involvement. Conclusions: Age, low BMI, immunosuppressive therapy, and ESRD are significant risk factors for disseminated TB and also significantly impact patient survival rates. These findings are of great importance for the development of clinical management and preventive measures.