Comparison of clinical manifestations and treatment outcome according to age groups in adult patients with miliary tuberculosis

Abstract

Background: After the introduction of chemotherapy, miliary tuberculosis (TB) has been more prevalent in adults than in children. However, adult patients have a wide age range and may have different characteristics across the age span. Thus, clinical manifestations and treatment outcome may differ according to age groups in adult patients with miliary TB. However, there is limited information regarding this issue.

Methods: Adult patients with miliary TB were retrospectively reviewed and were categorized into young (18-40 years), middle-aged (41-64 years), and old adults (≥65 years). The clinical manifestations and treatment outcome were compared among the three adult groups.

Results: Of 150 patients, 27, 35, and 88 patients composed the young, middle-aged, and old adult groups, respectively. Overall clinical manifestations were comparable among the three groups. Treatment completion was significantly lower and overall TB deaths were significantly higher in the old group than in the young group. However, deaths in the young and middle-aged groups were all TB-related deaths, whereas deaths in the old group were more attributable to TB-unrelated deaths rather than TB-related deaths. In multivariate analysis, underlying chronic condition, lower hemoglobin levels, and acute respiratory failure were independent predictors for TB-related deaths in the adult group <65 years, and lower albumin levels and acute respiratory failure were those in the adult group ≥65 years.

Conclusions: The present study suggests that treatment completion, the cause of death, and risk factors for TB-related deaths may be different according to age groups in adult patients with miliary TB.

Keywords: Miliary tuberculosis; cause of death; risk factors for mortality; treatment outcome.

Figure 1

Kaplan-Meier survival curve according to different age groups in adult patients with miliary tuberculosis. Young adults: 18–40 years; Middle-aged adults: 41–64 years; Old adults: ≥65 years. TB, tuberculosis.

Figure 2

Specific cause of tuberculosis (TB)-related and TB-unrelated deaths in old adult patients with miliary tuberculosis who died during anti-tuberculosis treatment.