Prevalence and short-term outcomes of acute complications of tuberculosis: a cross-sectional, monocentre, Italian study

Background: Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Acute complications may impact on disease progression but their prevalence is unclear and prognostic outcomes of complicated patients have been poorly studied. The aim of the study was to estimate the prevalence of acute complications of TB at the time of diagnosis. Short-term outcomes were also evaluated. Methods: A cross-sectional study was carried out in Milan (Italy), from January 2018 to December 2023. Results: 201 patients with TB were recruited. 88 complications were recorded in 65 (32.3%) patients. Disseminated TB was the most frequent complication (30, 34.1%) followed by acute respiratory failure (23, 26.1%) and pleural empyema (6, 6.8%). In-hospital and 30-days mortality in complicated patients were 9/65 (13.8%) and 10/65 (15.4%), respectively. In-hospital mortality was significantly higher in patients with > 1 versus (VS) 1 complication (6, 31.6% VS 3, 6.5%, p = 0.02) without any difference in 1-month mortality (6, 31.6% VS 4, 9.8%, p = 0.06) between subgroups. Acute respiratory failure was the most lethal complication. Conclusions: The study shows a substantial rate of complications in patients with a new diagnosis of TB associated to a significant short-term mortality. A prompt screen of complications at diagnosis is needed to improve short-term outcomes of these patients.