Factors influencing poor long-term outcomes in tuberculous pleurisy patients: A 9-year cohort study

To identify risk factors associated with poor long-term outcomes in patients with tuberculous pleurisy (TP) through a 9-year prospective cohort study.

From May 2014 to November 2018, a total of 464 patients diagnosed with TP were enrolled at Beijing Chest Hospital and followed up until November 2023, with a median follow-up duration of 7.1 years. Poor outcomes were defined as the occurrence of secondary empyema, recurrent pulmonary tuberculosis, or recurrent TP. Cox proportional hazards regression models were used to analyze prognostic factors associated with poor outcomes.

Bilateral TP was independently associated with an increased risk of poor outcomes (adjusted hazard ratio [aHR], 2.68; 95% confidence interval [CI], 1.41-5.09, P = 0.003). Patients receiving extended anti-tuberculosis therapy also exhibited a significantly higher risk (aHR, 3.55; 95% CI, 2.05-6.15; P < 0.001). In contrast, standardized treatment was associated with a 93% reduction in the risk of poor outcomes compared with non-standardized treatment (aHR, 0.07; 95% CI, 0.02-0.24; P <0.001).

Long-term prognosis in patients with TP is influenced by both disease severity, as reflected by bilateral pleural involvement and the need for extended treatment regimens, and the quality of clinical management, particularly adherence to standardized therapy. Early diagnosis and strict implementation of guideline-recommended treatment should be prioritized, especially among patients at higher risk of adverse outcomes.