Risk factors for the progression from pulmonary tuberculosis to spinal tuberculosis: a logistic regression analysis

This study aims to identify the risk factors for the progression from pulmonary tuberculosis (PTB) to spinal tuberculosis (STB), which is crucial for early disease intervention, optimizing treatment strategies, and improving patient prognosis.

A retrospective analysis was conducted on 326 patients diagnosed with PTB between January 2017 and October 2024. Demographic, clinical, and socioeconomic data were collected, including age, gender, body mass index (BMI), Karnofsky Performance Status (KPS), Nutritional Risk Screening 2002 (NRS-2002) score, diabetes, per capita income, smoking status, alcohol consumption, and a history of recurrent PTB. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for the progression to STB, and interaction effect analysis and risk stratification based on the NRS-2002 score were conducted to assess its predictive value.

Univariate logistic regression revealed that the NRS-2002 score (OR = 2.762, p < 0.001), recurrent PTB (OR = 15.370, p < 0.001), and living in relative poverty (OR = 10.000, p = 0.002) were significant risk factors for the progression from PTB to STB. Multivariate logistic regression confirmed that the NRS-2002 score (OR = 11.22, p < 0.001), recurrent PTB (OR = 5.08, p < 0.001), and living in relative poverty (OR = 2.58, p < 0.001) were independently associated with increased likelihood of STB progression. Stratified analysis revealed a clear dose-response relationship between higher NRS-2002 scores and the risk of progression to STB, with those having scores ≥ 6 exhibiting the highest odds (OR = 91.59, p < 0.001).

This study highlights critical risk factors for the progression from PTB to STB, particularly the NRS-2002 score, recurrent PTB, and socioeconomic status (living in relative poverty). The NRS-2002 score was identified as the most significant predictor, demonstrating a strong dose-response relationship with disease progression. Clinically, early identification of patients with elevated NRS-2002 scores, alongside timely nutritional interventions and efforts to alleviate poverty, can significantly reduce the risk of STB development. These findings can inform clinical decision-making, enhance early intervention strategies, and guide public health policies aimed at preventing STB, particularly in high-risk populations.