A valuable computed tomography-based new diagnostic tool for severe chest lesions in active pulmonary tuberculosis: combined application of influencing factors

Abstract

The objective of the present investigation was to explore the influencing factors and value of computed tomography (ct) for diagnosing severe chest lesions in active pulmonary tuberculosis (AptB). this retrospective investigation included 463 patients diagnosed with APTB. Relevant clinical features were collected. patients were assigned to mild/moderate group or advanced group depending on the lesion severity on chest CT, severe chest CT lesion refers to the moderately dense or less diffuse lesion that exceeds the total volume of one lung, or the dense fusion lesion greater than one third of the volume of one lung, or the lesion with cavity diameter ≥4 cm. Independent risk factors for severe lesions were determined by univariate and multivariate logistic regression analyses, and the diagnostic efficiency of the risk factors was assessed by receiver operating characteristic curve (ROC). Chest CT demonstrated that there were 285 (61.56%) cases with severe lesions; multivariate Logistic regression analysis showed dust exposure [odds ratio (oR) = 4.108, 95% confidence interval (CI) 2.416-6.986], patient classification (OR = 1.792, 95% CI 1.067-3.012), age (OR = 1.018, 95% CI 1.005-1.030), and albuminglobulin ratio (oR = 0.179, 95% CI 0.084-0.383) to be independently correlated with severe lesions on chest CT. ROC curve analysis showed the cutoff values of age, albumin-globulin ratio and combined score to be 39 years, 0.918 and −0.085, respectively. The predictive value of combined score area under the curve 0.753 (95% CI 0.708-0.798) was higher than that of any single factor. The combined score of these four factors further improved the predictive efficacy.

Analysis of risk factors for pulmonary tuberculosis with persistent severe inflammation

“…Our results demonstrated that one risk factor for persistent severe inflammation in TB patients was a large cavity on chest CT, and patients with large cavities tended to show nonconversion of sputum cultures, similar to the findings of a previous report [13] . During the course of TB, a cavity is formed when an expanding granuloma ruptures, [14] and a cavity with a diameter of 4 cm or more is considered a severe lesion [11] . In general, CRP levels are increased in pulmonary TB patients with extensive lung tissue damage, as the pulmonary inflammatory process is influenced not only by the large population of TB bacilli but also by the presence of lung damage, which is associated with lung tissue inflammation [3] .…”

“…Patients with a CRP level ≥9.0 mg/dL had a longer time until inflammation improvement than those with a CRP level <9.0 mg/dL (median (IQR) 20 days [13-43] vs 8 days [8][9][10][11][12][13][14], log rank test P < .001), and the hazard ratio was 2.37 (95% Cl: 1.70-3.30).…”

“…[ 13 ] During the course of TB, a cavity is formed when an expanding granuloma ruptures, [ 14 ] and a cavity with a diameter of 4 cm or more is considered a severe lesion. [ 11 ] In general, CRP levels are increased in pulmonary TB patients with extensive lung tissue damage, as the pulmonary inflammatory process is influenced not only by the large population of TB bacilli but also by the presence of lung damage, which is associated with lung tissue inflammation. [ 3 ] TB bacilli remaining in a cavity despite antituberculous treatment might induce not only infectious inflammation but also an inappropriate host response to self-antigens, causing autoimmune inflammation.…”

“…2D), [11] and a cheese-like appearance was identified based on lobar consolidation with multiple small voids inside (Fig. 2E) [11] …”

“…A large cavity was defined as an advanced lesion with a diameter of 4 cm or more (Fig. 2D), [11] and a cheese-like appearance was identified based on lobar consolidation with multiple small voids inside (Fig. 2E) [11] …”