• Timothy P W Jones, Susannah Dabbaj, Indrajeet Mandal, Joanne Cleverley, Charlotte Cash, LipmanMarc C IMCIDepartment of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, England; UCL Respiratory, University College London, Royal Free Campus, London, England., and David M Lowe.
• Department of Infection, Royal Free London NHS Foundation Trust, London, England.
• Chest. 2021 Dec 1; 160 (6): 2030-2041.

BackgroundLung disease after tuberculous confers significant morbidity. However, the determinants of persistent lung damage in TB are not well established. We investigated associations between TB-associated radiologic changes and sociodemographic factors, surrogates of bacillary burden, and blood inflammatory markers at initiation of therapy and after 1 month.Research QuestionWhat are the predictors of radiologic severity at the end of TB treatment for TB?Study Design And MethodsWe collected data from patients treated for drug-sensitive pulmonary TB at our center over a 5.5-year period. We recorded age, sex, ethnicity, smoking status, symptom duration, sputum smear grade, time to culture positivity, and blood results (C-reactive protein and neutrophil count) at baseline and after 1 month of treatment. Chest radiographs obtained at baseline, 2 months, and end of treatment were assessed independently by two radiologists and scored using a validated system. Relationships between predictor variables and radiologic outcomes were assessed using linear or binary logistic regression.ResultsWe assessed 154 individuals with a mean age of 37 years, 63% of whom were men. In a multivariate analysis, baseline radiologic severity correlated with sputum smear grade (P = 0.003) and neutrophil count (P < 0.001). At end of treatment, only the 1-month neutrophil count was associated significantly with overall radiologic severity in the multivariate analysis (r = 0.34; P = 0.003) and remained significant after controlling for baseline radiologic scores. The 1-month neutrophil count also was the only independent correlate of volume loss and pleural thickening at the end of treatment and was significantly higher in patients with persistent cavitation or effusion vs those without.InterpretationPersistent neutrophilic inflammation after 1 month of TB therapy is associated with poor radiologic outcome, suggesting a target for interventions to minimize lung disease after tuberculous.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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