Network analysis of symptom clusters among patients with pulmonary tuberculosis: a cross-sectional study

Patients with pulmonary tuberculosis (PTB) experience complex and co-occurring symptoms. Understanding the structure of these symptom clusters and their interrelationships is crucial for effective management. This study aimed to map the symptom network and identify core symptoms and clusters among PTB patients in China and targets for precise intervention.

A convenience sampling method was used to recruit 356 pulmonary tuberculosis patients between November 2024 and April 2025 from Shenzhen Third People's Hospital. Data were collected using a sociodemographic questionnaire and the Chinese version of the Memorial Symptom Assessment Scale (MSAS-C), a valid and reliable instrument (Cronbach's α = 0.87) for this population. Data normality was assessed using Shapiro-Wilk tests; non-normally distributed continuous variables were expressed as median and interquartile range. Exploratory factor analysis was used to identify symptom clusters, and a symptom network was analyzed using the qgraph package in R, with strength centrality serving as the primary metric for identifying core symptoms.

The exploratory factor analysis demonstrated appropriate sampling adequacy, as indicated by a KMO value of 0.643 and a significant Bartlett's test of sphericity (χ²= 661.633, p < 0.001). This study identified four symptom clusters in patients with pulmonary tuberculosis: nutritional deficiency symptoms (eigenvalue = 2.001), inflammatory-related symptoms (eigenvalue = 1.692), somatic discomfort symptoms (eigenvalue = 1.563), and respiratory system-related symptoms (eigenvalue = 1.529). These four clusters collectively accounted for 54.76% of the total variance. The symptom network revealed edge weights ranging from |r| = 0.01 to 0.42, and centrality indices demonstrated good stability (correlation stability coefficient of strength = 0.689). Core symptoms included difficulty sleeping (strength rs = 2.691), fatigue (rs = 2.681), lack of appetite (rs = 2.654), and weight loss (rs = 2.604).

These findings identified four symptom clusters in pulmonary tuberculosis patients, with difficulty sleeping, fatigue, lack of appetite, and weight loss constituting the core symptoms. A targeted management strategy should prioritize these core symptoms through structured monitoring and intervention. Future longitudinal studies are needed to validate symptom dynamics and develop PTB-specific assessment tools.

Not applicable.