Among more than 18,000 patients treated for tuberculosis at a single Chinese hospital, 1,665 had tuberculous pleural effusion. A new analysis of this large patient cohort identifies who is most likely to develop the complication and, among those who do, which factors predict survival.
The study, published in Annals of Clinical Microbiology and Antimicrobials, drew on all tuberculosis patients admitted to Shanghai Pulmonary Hospital between January 2014 and December 2020. Of the 18,258 patients enrolled, 1,665 had tuberculous pleural effusion. The researchers used univariate and multivariate logistic regression to identify risk factors for the condition, and univariate and multivariate Cox proportional hazards models to assess prognostic factors among affected patients.
Three characteristics emerged as independent risk factors for developing pleural effusion during tuberculosis. Male gender carried an adjusted odds ratio of 1.284, with a 95 percent confidence interval of 1.153 to 1.429 and a p value below 0.001. Age of 70 years or older carried an adjusted odds ratio of 1.280, with a confidence interval of 1.102 to 1.485 and a p value of 0.001. The strongest single factor was a history of psychiatric disorders, which more than doubled the odds with an adjusted odds ratio of 2.450, spanning a confidence interval of 1.217 to 4.903 and a p value of 0.012.
The univariate analysis produced closely matching estimates, with male gender at an odds ratio of 1.276, older age at 1.275, and psychiatric history at 2.565. The consistency between the unadjusted and adjusted models suggests these associations were not explained by other measured variables in the cohort, although the authors note the analysis reflects a single hospital population in China and cannot by itself establish causal relationships.
Prognosis told a different story. Among patients who had developed tuberculous pleural effusion, two factors predicted death. Age of 70 years or older carried a hazard ratio of 5.207 in the multivariate Cox model, with a confidence interval of 2.043 to 13.267 and a p value below 0.001. Diabetes carried a hazard ratio of 3.530, with a confidence interval of 1.007 to 12.377 and a p value of 0.049, a result that sits just inside the conventional threshold for statistical significance.
In contrast, one factor was clearly protective. Patients who received whole-course management, meaning coordinated care spanning the entire treatment period, had a significantly lower risk of death, with an adjusted hazard ratio of 0.319, a confidence interval of 0.119 to 0.853 and a p value of 0.023. In univariate analysis the protective effect was similar, at a hazard ratio of 0.291. Taken together, the mortality models suggest that older patients with diabetes face the highest risk, while continuity of care may substantially reduce it.
The scale of the cohort lends weight to the findings. With more than 18,000 tuberculosis patients admitted over a seven-year period, the study captures a broad cross-section of disease severity and comorbidity, and the sheer number of pleural effusion cases, 1,665, gives the regression models a solid foundation. The psychiatric disorder association, though based on a smaller subset of patients as reflected by its wider confidence interval, was the strongest single risk factor for tuberculous pleural effusion in this cohort.
The mortality findings carry particular weight for aging tuberculosis populations.
The authors frame the work as an elucidation of the epidemiological characteristics associated with the risk and prognosis of tuberculous pleural effusion among tuberculosis patients in China. As an observational, single-center study, it identifies associations rather than proven causes, and its findings may not generalize to settings with different patient demographics, tuberculosis strains or health system structures.
Subject of Research: Risk factors and prognostic outcomes of tuberculous pleural effusion among tuberculosis patients in a large Chinese hospital cohort
Article Title: Risk factors and prognosis of Tuberculous pleural effusion in TB patients
Article References: Fang, Y., Wang, Y.-W., Yan, L.-P., Zhou, Q.-Q., Liang, L., Liu, Z.-H., Sha, W., & You, X.-F. (2026). Risk factors and prognosis of Tuberculous pleural effusion in TB patients. Annals of Clinical Microbiology and Antimicrobials. https://doi.org/10.1186/s12941-026-00893-0
Image Credits: AI Generated
DOI: 10.1186/s12941-026-00893-0
Keywords: tuberculosis, tuberculous pleural effusion, risk factors, prognosis, diabetes, Cox regression, logistic regression, Shanghai Pulmonary Hospital, extrapulmonary tuberculosis, mortality, whole-course management, elderly patients
News Source: Glenn Wilkins. (October 28, 2026). Age, Diabetes and Psychiatric History Shape Outcomes in Tuberculous Pleural Effusion. Scienmag.
