YUAN Jianlin 1 , FENG Haipan 2 , LUO Yuanming 3 , WEI Hailong 4 , GE Huiqing 5 , LIU Huiguo 6 , ZHANG Jianchu 7 , PAN Pinhua 8 , LI Xianhua 9 , XIE Xiufang 9 , ZHOU Hui 10 , ZHANG Jiarui 1 , PENG Lige 1 , PU Jiaqi 1 , ZHOU Haixia 1 , YI Qun 11
  • 1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
  • 2. Department of Respiratory and Critical Care Medicine, Chengdu SichuanSixth People's Hospital, Chengdu Sichuan 610051, P.R.China;
  • 3. State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, Guangdong510000, P.R.China;
  • 4. Department of Respiratory and Critical Care Medicine, Leshan People's Hospital of Sichuan Province, Leshan , Sichuan 614000, P.R.China;
  • 5. Department of Respiratory and Critical Care Medicine, Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R.China;
  • 6. Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R.China;
  • 7. Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R.China;
  • 8. Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha , Hubei 410000, P.R.China;
  • 9. Department of Respiratory and Critical Care Medicine, Neijiang First People's Hospital, Neijiang, Sichuan 641000, P.R.China;
  • 10. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Chengdu SichuanUniversity, Chengdu, Sichuan 610081, P.R.China;
  • 11. Sichuan Cancer Hospital, Chengdu, Sichuan 610042, P.R.China;
ZHOU Haixia, Email: zhouhaixia925@163.com; YI Qun, Email: yiqun925@126.com
chronic obstructive pulmonary disease; acute exacerbation; active pulmonary tuberculosis; predictive factors; clinical features
10.7507/1671-6205.202406089
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Objective To study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.Results A total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. Conclusion It is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.

Citation： YUAN Jianlin, FENG Haipan, LUO Yuanming, WEI Hailong, GE Huiqing, LIU Huiguo, ZHANG Jianchu, PAN Pinhua, LI Xianhua, XIE Xiufang, ZHOU Hui, ZHANG Jiarui, PENG Lige, PU Jiaqi, ZHOU Haixia, YI Qun. Clinical characteristics, predictive factors and short-term prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease complicated with active pulmonary tuberculosisin. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(9): 609-616. doi: 10.7507/1671-6205.202406089 Copy

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