Characteristics and factors associated with treatment delay in pleural tuberculosis

Background: Current strategies for the prevention, diagnosis and treatment of pleural TB have been inadequate, several challenges and issues related with pleural TB have been reported. Aim: To summarize the main features of pleural tuberculosis (TB) and determine the risk factors in treatment delay. Design: Retrospective analysis of hospital records. Methods: Consecutive confirmed TB patients with pleural effusion were enrolled in the study. Demographic and epidemiological data were collected from electronic medical records. Treatment delay duration was stratified into two categories: <30 days and >= 30 days. Multivariate logistic regression analysis was used to evaluate risk factors for the delay. Results: From July 2011 to September 2015, a total of 723 patients were enrolled, 72.1% of patients had pulmonary TB, 8.9% had empyema, 8.9% were multidrug-resistant TB (MDR-TB). Multivariate analysis revealed that MDR-TB (odds ratios (OR) = 2.485, 95% confidence interval (CI) 1.347, 4.587), pulmonary TB (OR = 1.452, 95% CI 1.010, 2.087) and empyema (OR = 4.355, 95% CI 2.185, 8.680) were significant risk factors for treatment delay, while fever (OR = 0.519, 95% CI 0.362, 0.744) as well as pleural protein (>= 45 g/l) (OR = 0.470, 95% CI 0.332, 0.667) were the protective factors. Conclusion: MDR-TB, pulmonary TB and empyema were significant risk factors for treatment delay, while fever and high pleural protein were protective factors. Tuberculous empyema remains a major problem in China, adequate awareness should be created for the management.