A high C‐reactive protein level and poor performance status are associated with delayed sputum conversion in elderly patients with pulmonary tuberculosis in Japan

Abstract

Introduction Although the aging population had been increasing in many countries, the factors associated with sputum conversion in elderly patients with pulmonary tuberculosis have not been fully elucidated. Objectives We aimed to identify the predictors of delayed sputum conversion and to assess the impact of non‐conversion on mortality during tuberculosis treatment in elderly patients. Methods Elderly patients (>65 years) admitted at our hospital in Japan for sputum smear‐positive pulmonary tuberculosis were included. The risk factors for sputum non‐conversion after 2 months of treatment were determined using multiple logistic regression. Cox hazard regression was used to assess the influence of non‐conversion on mortality. Results We included 185 patients, with median age of 82 years (IQR, 79‐88 years). The median time to conversion was 47 (95% CI 43‐51) days, and 62 (34%) were identified as non‐converters. Multivariate analysis showed that high pretreatment smear grade, high C‐reactive protein level and poor performance status were associated with non‐conversion. Non‐conversion did not contribute to death during treatment. Conclusions In elderly patients, inflammation level and physical activity level, along with initial smear grade may have a significant impact on delayed sputum conversion. Non‐conversion after two months of treatment might not be related with mortality.

Effect of Big Data Analysis-Based Remote Management Combined with Yangyin Runfei Decoction on Coagulation Function, Pulmonary Function, and Quality of Life of Pulmonary Tuberculosis Patients

“…D-D has higher antigenicity, which is the product of fibrin after being hydrolyzed by plasmin, and its elevated level represents that patients' body fibrinolytic system is activated, and their blood is in a hypercoagulable state. A prolonged TT indicates an abnormality in the common coagulation pathway, and elevated PLT means a hyperfunctional state of the patient body, and the reason may be that tuberculosis bacteria lead to coagulation and thrombus and eventually trigger histopathological damage and cell adhesion [ 23 , 24 ]. In this experiment, various coagulation indicators were obviously lower in EG than in CG ( P < 0.001), indicating that big data analysis-based remote management combined with Yangyin Runfei decoction could effectively relieve the hypercoagulable state in patients' blood and achieve better treatment effect.…”

Prediction model for death in patients with pulmonary tuberculosis accompanied by respiratory failure in ICU: retrospective study

“…Albuquerque et al found that C-reactive protein was strong discriminators of active TB and thus could be considered as biomarkers useful in discrimination different TB clinical forms (35). Another study found high C-reactive protein level was associated with sputum smear turn to negative (36). The association between C-reactive protein levels and outcome has not previously been investigated in TB patients with respiratory failure, so our study is the first to show that high C-reactive protein levels are associated with fatal outcome.…”

Association between sputum conversion and in-hospital mortality in elderly patients with pulmonary tuberculosis: a retrospective study

“…Non-conversion of sputum within 2 months is widely recognized as a poor prognostic factor in patients with pulmonary TB [ 7 – 11 ]. However, we previously reported that in elderly patients with pulmonary TB, sputum conversion within 2 months did not contribute to the prognosis [ 17 ]. This study showed that sputum non-conversion within 90 and 120 days, not within 2 months, was associated with in-hospital mortality.…”

“…Information regarding this research was posted at the hospital, with an opt out method. Some of the subjects included in this study had already participated in previous studies [ 17 – 22 ].…”

“…We previously reported that sputum conversion within 2 months after the start of treatment was not related to prognosis in elderly patients with pulmonary TB [ 17 ]. In elderly patients, sputum conversion may be delayed due to the age-related decline in the immune function.…”