Study to identify incidence and risk factors associated Residual pleural opacity in tubercular pleural effusion.

INTRODUCTION: Residual pleural opacity (RPO) is a common radiographic sequela in patients with tubercular pleural effusion at the end of the treatment. This study was designed to find out the risk factors associated with residual pleural opacity (RPO). MATERIALS & METHODS: This was a prospective longitudinal study performed to analyse data of 56 patients (46 males & 10 females) who were diagnosed as tubercular pleural effusion and treated for the same between 1st Jan 2019 to 30th March 2020. Chest X-ray posteroanterior & Lateral view was done (performed) at 0 and 6 months of treatment to quantify the amount of pleural effusion and measured the residual pleural opacity at the end of the treatment. RPO included both non resolving pleural effusion as well as residual pleural thickening (RPT). All statistical analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Multivariate logistic regression was performed to explore the association of risk factors and Residual pleural opacity. The statistical significance level was set at 0.05 (two-tailed). RESULTS: The incidence of Residual pleural opacity (RPO) at the end of 6 months of antituberculosis treatment was 53.57% (30/56)). The study patients were divided into RPO and non- RPO group. Male gender had significantly higher incidence of RPO (93.3% vs 69.2% P = 0.01)). Patients with RPO group had significantly more cough and weight loss as compared to non RPO group (96.6% vs 65.3% P = 0.002 and 60% vs 23% P = 0.005). The proportion of patients who underwent therapeutic aspiration and gained weight of more than 5kg during treatment (19.5% vs 7.6% P = 0.02 & 46.6% vs 7.6% P = 0.001) was significantly higher in RPO group. A significantly lower protein, glucose and higher LDH level in pleural fluid was observed in the RPO group compared to non-RPO group (P = 0.006, P = 0.01, P = 0.001)). No significant difference was found in the pleural fluid ADA, lymphocyte, neutrophil levels between the two groups (p > 0.05). Logistic regression analysis showed that the male gender, low pleural fluid glucose, presence of cough and weight loss were associated with significantly increased risk of residual pleural opacity and thickening (p < 0.05). CONCLUSION: Tubercular pleural effusion is associated with residual pleural opacity in more than half of the patients. Male gender and low glucose levels in pleural fluid was associated with increased risk of residual pleural opacity.

Identification of risk factors for radiological sequelae in patients treated for pulmonary tuberculosis: Prospective observational cohort study.

OBJECTIVE OF STUDY: This study is designed to assess risk factors & magnitude of residual radiological lesion in patients treated for pulmonary tuberculosis. METHODS: This is a retrospective observational cohort study which included patients who were newly diagnosed as pulmonary tuberculosis and have completed 6 months of treatment. STATISTICAL ANALYSIS: Categorical data were expressed as proportion and continuous data were expressed as mean ± SD. The obtained data were analysed by means of frequency distribution table and descriptive statistics using SPSS version 20 for Windows (SPSS Inc., Chicago, Ill, USA) and Chi-square test and student t test were used for statistical analysis. We assessed association between risk factors and development of radiological sequelae, using univariate statistical analysis and odds ratio. P-values less than 0.05 were considered statistically significant. RESULTS: Data from 128 patients was used for analysis. The average age in this cohort was 32.84 ± 17.47 years and 68.75% patients were male. Residual x-ray lesions were observed in 92 (71.87%) cases out of 128 study patients. 72.82% of residual lesions appeared as parenchymal fibrosis, 13.04% as bronchiectasis, 2.17% as cavity & 3.26% appeared as calcification. Patients with advanced lesions (34.78% vs 16.66%), bilateral lesions (29.34% vs 11.11%) or cavity (18.47% vs 2.77%) in chest x-ray or Sputum smear positivity for AFB were found to have significant radiological sequelae. Among the variables associated with the risk of having pulmonary tuberculosis sequelae were cavity (OR: 7.03), sputum smear positive for AFB (OR: 4.03), Advanced lesions (OR: 3.38) & bilateral lesions (OR: 2.90) in chest x-ray. CONCLUSION: This study concluded that a large number of patients remain with residual radiological sequelae despite good clinical response. Patients with extensive lesions, presence of cavity or bilateral involvement in chest x-ray and sputum smear positive for acid fast bacilli were often associated with residual radiological opacity.