Malnutrition is Associated with an Increased Risk of Death in Hospitalized Patients with Active Pulmonary Tuberculosis: A Propensity Score Matched Retrospective Cohort Study

Xiaoqun Xu; Houyong Zhu; Long Cai; Xinyu Zhu; Hanxin Wang; Libin Liu; Fengwei Zhang; Hongjuan Zhou; Jing Wang; Tielong Chen; Kan Xu

doi:10.2147/IDR.S382587

Malnutrition is Associated with an Increased Risk of Death in Hospitalized Patients with Active Pulmonary Tuberculosis: A Propensity Score Matched Retrospective Cohort Study

Infect Drug Resist. 2022 Oct 26:15:6155-6164. doi: 10.2147/IDR.S382587. eCollection 2022.

Authors

Xiaoqun Xu^#^{1

2}, Houyong Zhu^#³, Long Cai^#^{1

2}, Xinyu Zhu⁴, Hanxin Wang⁵, Libin Liu^{1

2}, Fengwei Zhang^{1

2}, Hongjuan Zhou^{1

2}, Jing Wang^{1

2}, Tielong Chen³, Kan Xu^{1

2}

Affiliations

¹ Centre of Laboratory Medicine, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
² Centre of Laboratory Medicine, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, People's Republic of China.
³ Department of Cardiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.
⁴ Department of Cardiology, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
⁵ The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background: This study aimed to investigate whether nutrition levels in patients with active pulmonary tuberculosis (TB) affect their risk of all-cause mortality during hospitalization and to further evaluate the predictive ability of Geriatric Nutritional Risk Index (GNRI) and Body Mass Index (BMI) for risk of all-cause mortality.

Methods: Patients from January 1, 2020 to December 31, 2021 were retrieved, and a total of 1847 were included. The primary outcome was all-cause mortality. Propensity score matching (PSM) was performed for risk adjustment, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive ability of GNRI and BMI for all-cause mortality.

Results: Malnourished TB patients were older, had more congestive heart failure, and had more chronic obstructive pulmonary disease or asthma. Under the nutrition level grouping defined by GNRI, the all-cause mortality in the malnourished group did not appear to reach a statistical difference compared with the nonmalnourished group (P = 0.078). When grouped by level of nutrition as defined by BMI, the all-cause mortality was higher in the malnourished group (P = 0.009), and multivariate logistic regression analysis revealed that malnutrition was an independent risk factor for all-cause mortality. After propensity score matching, the results showed that the all-cause mortality was higher in the malnutrition group, regardless of BMI or GNRI defined nutrition level grouping, compared with the control group (both P < 0.001). The ROC curve analysis revealed that the area under the curve (AUC) was 0.811 ([95% confidence interval (CI) 0.701-0.922], P < 0.001) for GNRI and 0.728 ([95% CI 0.588-0.869], P = 0.001) for BMI.

Conclusion: In the clinical treatment of patients with active TB, more attention should be paid to the management of nutritional risk. GNRI may be a highly effective and easy method for predicting short-term outcomes in patients with active pulmonary TB.

Keywords: Geriatric Nutritional Risk Index; body mass index; malnutrition; tuberculosis.

Grants and funding

This study was supported by the Health Commission of Zhejiang Province (2023KY969 and 2021KY916), the Hangzhou Red Cross Hospital Young Fund (HHQN2021006), the Hangzhou Municipal Health Commission (A20210115), and the Hangzhou Key Discipline of Integrated Traditional Chinese and Western Medicine (2020SJZDXK06). All sponsors mainly provide remuneration or gratuities for lectures, speeches, speaker offices, manuscript writing or educational activities, and do not play any role in research design, data collection and analysis or decisions to submit articles for publication.