Clinical Determinants of Early Structural Lung Damage Following Intensive Tuberculosis Therapy: A Prospective Cohort Study

Abstract

BACKGROUND: Post-tuberculosis lung disease (PTLD) is an important cause of persistent respiratory morbidity, yet clinical factors associated with structural lung abnormalities during anti-tuberculosis treatment remain poorly understood. This study explored routinely available clinical factors associated with early structural lung damage following completion of the intensive treatment phase. METHODS: This prospective cohort study included 38 adults with newly diagnosed, microbiologically confirmed, drug-susceptible pulmonary tuberculosis. Baseline demographic, clinical, and laboratory data were collected before treatment initiation. Early structural lung damage was evaluated by chest radiography after the 2-month intensive phase. Univariable and multivariable logistic regression analyses were performed to identify clinical factors associated with early structural lung damage. Receiver operating characteristic analysis was conducted to describe the performance of significant laboratory variables. RESULTS: Radiographic evidence of early structural lung damage was identified in 31 participants (81.57%). Underweight nutritional status was more frequent among participants with fibrosis ( P = 0.002). After multivariable adjustment, platelet count remained independently associated with early structural lung damage (adjusted OR 0.986, 95% CI 0.972-1.000; P = 0.047), whereas random blood glucose was not. Platelet count and random blood glucose yielded AUC values of 0.742 and 0.776, respectively. CONCLUSION: Platelet count remained independently associated with early structural lung damage after the intensive phase of anti-tuberculosis treatment, whereas underweight nutritional status was more common among participants with radiographic fibrosis. These findings warrant validation in larger multicenter prospective studies before informing clinical risk assessment.

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