Characteristics and predictors of mortality among infants and toddlers hospitalized with tuberculosis: a ten-year case series study in Sichuan, China.

Abstract

Background: Research on tuberculosis (TB) in infants and toddlers is limited in China. This study aims to describe the epidemiology of TB in this age group and identify predictors of mortality during hospitalization.

Methods: A retrospective study was conducted at the Chengdu Public Health Clinical Medical Center (CDPHCC), focusing on 252 children aged 3 years or younger who were treated for TB between January 2013 and December 2023. Epidemiological and clinical data were collected for analysis. Simple and multiple logistic regression models were used to identify factors associated with mortality during hospitalization in infants and toddlers.

Results: The study included 97 infants and 155 toddlers. A smaller proportion of infants lived in rural areas compared to toddlers (76/97 vs. 140/155, P = 0.008). Additionally, more families of toddlers had two or more TB patients compared to families of infants (19/155 vs. 2/97, P = 0.008). A higher number of individuals from minority ethnic groups were unvaccinated with Bacille Calmette-Guérin (BCG) compared to Han individuals in both the infant (16/37 vs. 45/60, P = 0.002) and toddler (18/41 vs. 83/114, P = 0.001) groups. The most common symptoms reported were cough (n = 190, 75.4%) and fever (n = 187, 74.2%), with polypnea showing significant differences between the groups (P = 0.000). Significant differences were observed in the prevalence of miliary pulmonary TB and TB meningitis (TBM) (P < 0.05). The mortality rate was higher in infants compared to toddlers (13.4% vs. 5.2%, P = 0.021) during hospitalization. Multivariate analysis indicated that miliary pulmonary TB (PTB), hydrocephalus, and hypoproteinemia were associated with increased in-hospital mortality.

Conclusions: Infants with TB are more likely to develop miliary PTB and TBM than toddlers, resulting in higher in-hospital mortality rates. Miliary PTB, hydrocephalus, and hypoproteinemia are significant prognostic factors for mortality among hospitalized infants and toddlers with TB in China.