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

Background Previous studies have identified several risk factors for death because of TB, including advanced age, HIV coinfection, multidrug-resistant TB, malnutrition, low activities of daily living, and comorbidities. In Japan, the incidence of TB and TB-related deaths is consistently higher among older individuals. However, few studies have evaluated the risk factors for death in older adult patients with TB. Research question What are the risk factors for death among older adults with TB? Study design and methods This prospective cohort study included data on consecutive older adult patients (aged ≥ 65 years) who were admitted for treatment of TB between October 2016 and April 2022. We collected data on patient characteristics, chest radiography findings, and laboratory data and assessed whether these parameters were associated with patient death. We also examined the risk factors associated with TB-related and TB-unrelated deaths as a subanalysis. Results Multivariate Cox proportional hazards analysis showed that performance status (hazard ratio [HR], 1.434; 95% CI, 1.051-1.956; P = .023), corticosteroid use (HR, 2.679; 95% CI, 1.374-5.221; P = .004), and serum albumin levels (HR, 0.434; 95% CI, 0.235-0.804; P = .008) were significantly correlated with all-cause mortality. Subanalyses demonstrated that performance status was significantly correlated with TB-related death (HR, 2.048; 95% CI, 1.459-2.874; P < 0.001), whereas advanced age (HR, 1.073; 95% CI, 1.008-1.142; P = .027), corticosteroid use (HR, 4.131; 95% CI, 1.783-9.575; P < .001), and serum albumin levels (HR, 0.435; 95% CI, 0.225-0.842; P = .014) were significantly correlated with TB-unrelated deaths. Interpretation The evaluation of daily activity, physical ability, immune status, and nutritional status is considered an important factor directly related to prognosis in the treatment of TB in older adults. Large-scale prospective studies should be conducted in the future.