van Arkel Cynthia, Storms Iris, Kurver Lisa, Smeenk Frank, Wielders Pascal, Hoefsloot Wouter, Carpaij Neeltje, Boeree Martin J, van Crevel Reinout, van Laarhoven Arjan, Magis-Escurra Cécile
Department of Pulmonary Disease and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Department of Pulmonary Diseases, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands.
J Infect. 2024 Aug;89(2):106200. doi: 10.1016/j.jinf.2024.106200. Epub 2024 Jun 18.
Susceptibility to respiratory infections increases with age. Diagnosing and treating tuberculosis in the elderly comes with the challenges of fewer specific symptoms and possibly more side effects of treatment. Much is unknown when it comes to tuberculosis in the elderly, especially in relation to inflammation, which may impact mortality. We, therefore, investigated a clinical cohort of elderly tuberculosis patients.
Patients aged ≥65 years, admitted to our tuberculosis reference center between 2005 and 2021, were retrospectively included in our cohort. Sociodemographic data, clinical characteristics, laboratory results, including inflammatory markers at baseline (monocyte, neutrophil, lymphocyte count, and CRP levels), and treatment outcomes were collected. They were compared to the National Dutch TB Registry and analyzed using descriptive statistics. Survival analysis was performed using univariate Cox regression analysis and a log-rank test. Results were visualized in Kaplan-Meier curves.
104 elderly tuberculosis patients, mostly European, with a mean age of 75 years, were included. None were HIV-infected. Miliary tuberculosis cases were overrepresented (14 %) compared to the National Dutch TB Registry (5 % in elderly, 2 % adults). Fever occurred in 77 % (57/74), and the duration of fever decreased with age. Innate immune markers, including monocyte/lymphocyte-ratio, moderately correlated with CRP. Overall mortality was 15 %, and highest (33 %) in patients with CRP levels >100 mg/mL.
In elderly tuberculosis patients in a low-incidence setting, mortality rates are higher in comparison to younger patients. The overrepresentation of miliary tuberculosis may suggest waning immunity, with a subset of patients exhibiting strong inflammation associated with increased mortality.
呼吸道感染的易感性随年龄增长而增加。老年人结核病的诊断和治疗面临着特定症状较少以及治疗副作用可能更多的挑战。关于老年人结核病，尤其是与可能影响死亡率的炎症相关的情况，仍有许多未知之处。因此，我们对老年结核病患者的临床队列进行了调查。
回顾性纳入2005年至2021年间入住我们结核病参考中心的年龄≥65岁的患者。收集社会人口统计学数据、临床特征、实验室检查结果，包括基线时的炎症标志物（单核细胞、中性粒细胞、淋巴细胞计数和CRP水平）以及治疗结果。将其与荷兰国家结核病登记处的数据进行比较，并使用描述性统计进行分析。使用单变量Cox回归分析和对数秩检验进行生存分析。结果以Kaplan-Meier曲线呈现。
纳入了104例老年结核病患者，大多数为欧洲人，平均年龄75岁。均未感染HIV。与荷兰国家结核病登记处相比，粟粒性结核病例的比例过高（14%，而荷兰国家结核病登记处老年患者中为5%，成年人中为2%）。77%（57/74）的患者出现发热，发热持续时间随年龄增长而缩短。包括单核细胞/淋巴细胞比值在内的先天免疫标志物与CRP呈中度相关。总体死亡率为15%，CRP水平>100mg/mL的患者死亡率最高（33%）。
在低发病率地区的老年结核病患者中，与年轻患者相比死亡率更高。粟粒性结核病例比例过高可能提示免疫力下降，部分患者表现出与死亡率增加相关的强烈炎症反应。
