Prior pulmonary tuberculosis deteriorated all-cause mortality in AECOPD patients after discharge

Chronic obstructive pulmonary disease (COPD) patients who have a history of pulmonary tuberculosis (PTB) often present with worse dyspnea and more acute exacerbations (AEs). However, the impact of prior PTB on prognosis in AECOPD patients remains to be further investigated. The diagnosis of patients with prior PTB was based on a combination of imaging and prior tuberculosis history. This study compared the clinical characteristics and prognosis of the Chinese AECOPD inpatients with or without prior PTB, and discussed the role of glucocorticoids in the prognosis of AECOPD patients with prior PTB by Kaplan-Meier analysis and Cox Regression analysis. 740 inpatients enrolled, and 231 patients (31.2%) were considered as the PTB group. The PTB group had obviously higher 1-year mortality (19.4% vs. 10.7%, P = 0.003) and long-term mortality (47.6% vs. 33.3%, P = 0.001) after discharge. Moreover, discharged AECOPD patients were defined as group E in the stable stage, and these group E patients with prior PTB using inhaled corticosteroid (ICS) during the stable stage were found to have lower mortality than those who did not use ICS after discharge. The predictors of ICS use decreasing all-cause mortality among these E group patients with PTB included patient characteristics, and CAT ≥ 20 was the strongest predictor (HR, 0.043; 95% CI, 0.006-0.331; P < 0.01). In this study, more than 30% of AECOPD patients had prior PTB, and the mortality of discharged AECOPD patients with prior PTB was significantly greater than that of those without. Surprisingly, ICS use during the stable stage appears to be associated with improved survival in discharged AECOPD patients who had prior PTB, and the strongest predictors of the association were CAT ≥ 20.