Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan

Who

• Participants: Older adult patients with tuberculosis (TB)

• Sample size: 126 patients included in final analysis

  • 84 survivors

  • 42 nonsurvivors

• Age: ≥65 years (median age: 84 years)

• Sex: 63 male patients

• Key characteristics: Many patients were underweight (median BMI 19.0 kg/m²) and had relatively preserved oxygenation at admission (median PaO₂/FIO₂ 368.6 mm Hg).

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What

• Focus: Identification of prognostic factors associated with all-cause mortality, TB-related death, and TB-unrelated death in older patients with TB.

• Main findings:

  • Poor performance status (PS > 2), corticosteroid use, and low serum albumin levels (≤2.6 g/dL) were independently associated with increased all-cause mortality.

  • Mortality risk increased stepwise with the number of these risk factors.

  • PS was the strongest predictor of TB-related death.

  • Age, corticosteroid use, and low serum albumin were independently associated with TB-unrelated death.

• Implications: Functional status, immune suppression, and nutritional status are key determinants of prognosis in older patients with TB and should be carefully assessed during treatment.

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When

• Study period: October 2016 to April 2022

• Follow-up duration: 1 year after hospital admission for TB

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Where

• Setting: NHO Ehime Medical Center, Japan

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Why

• Older adults with TB experience high mortality, but prognostic factors—particularly distinguishing TB-related from TB-unrelated deaths—are not well defined.

• The study aimed to address this gap to improve risk stratification and management in this vulnerable population.

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How

• Study design: Prospective cohort study

• Inclusion criteria: Patients ≥65 years with bacteriologically confirmed TB, including extrapulmonary TB without pulmonary lesions

• Exclusions: No bacteriological confirmation, prior recent TB treatment, age <65 years, or incomplete data

• Data collected:

  • Demographics, BMI

  • Performance status (ECOG PS)

  • Comorbidities and corticosteroid use

  • Radiographic findings (cavities, pleural effusion)

  • Laboratory data (e.g., lymphocyte count, CRP, serum albumin)

• TB diagnosis: Positive culture from at least one infected site; TRCReady-80 transcription–reverse transcription concerted reaction method

• Outcomes: All-cause mortality, TB-related death, TB-unrelated death

• Analysis:

  • Multivariate Cox proportional hazards models

  • Receiver operating characteristic (ROC) curves for cutoff determination

  • Kaplan–Meier survival analysis with risk stratification

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Key Conclusion

Poor performance status, corticosteroid use, and hypoalbuminemia are strongly associated with mortality in older adults with TB. Comprehensive evaluation of daily functioning, physical capacity, immune status, and nutrition is critical and may directly influence prognosis.

Source: Miyoshi, S., Semba, M., Tanabe, M., Sato, C., Watanabe, A., Ito, R., Kubota, M. and Abe, M., 2025. Assessment of Risk Factors for Death in Older Adult Patients With TB in Japan. CHEST Pulmonary, 3(2).