Prediction of tuberculosis-specific mortality for older adult patients

A retrospective cohort study aimed to identify the risk factors associated with tuberculosis-specific mortality (TSM) in older adult patients with pulmonary tuberculosis and to develop a predictive model using a competing risk framework. The study analyzed data from 528 patients aged 65 years and older, collected between 2015 and 2020 across 14 infectious disease hospitals in Henan Province, China. Among the study population, there were 97 deaths—50 were attributed to tuberculosis (9.5%) and 47 to non-tuberculosis-specific causes (8.9%). The 5-year cumulative incidence functions (CIFs) were 9.7% for TSM and 9.4% for non-TSM, highlighting the need to distinguish between different mortality risks in this population.

The analysis identified several significant predictors for TSM. Patients aged 85 years and older had nearly a threefold increased risk (HR 2.96), while those undergoing retreatment (HR 2.53), presenting with chest X-ray cavities (HR 5.11), hypoalbuminemia (HR 3.17), or elevated CRP levels (≥10 mg/L) were also at higher risk. For non-TSM, advanced age (≥85 years; HR 4.48) and elevated CRP levels (HR 2.67) were the most influential factors. These findings underscore the importance of specific clinical and inflammatory markers in shaping patient prognosis and directing care priorities for older adults with pulmonary TB.

A competing risk nomogram was developed using the Fine and Gray model to predict 3- and 5-year TSM probabilities, demonstrating strong predictive performance with a C-index of 0.844. The calibration plot confirmed close agreement between predicted and observed outcomes. Overall, the study concludes that age, treatment category, chest radiographic findings, nutritional status, and systemic inflammation are independent predictors of TSM. This nomogram provides a valuable tool to aid clinicians in risk stratification and personalized treatment planning for elderly TB patients.

Source: Wang, S., Gu, R., Ren, P., Chen, Y., Wu, D. and Li, L., 2025. Prediction of tuberculosis-specific mortality for older adult patients with pulmonary tuberculosis. Frontiers in Public Health, 12, p.1515867.