Analysis of factors influencing high infectivity in patients with tuberculosis using clinical and imaging methods

To optimise early screening for hospitalised patients with highly contagious tuberculosis (TB) to allow for effective isolation measures to reduce the risk of TB transmission. Data were collected from 9458 newly diagnosed patients with TB from 1 January 2015 to 31 December 2023 at a designated TB hospital in Tianjin. The patients were divided into two groups based on their infection status: highly infectious and less infectious. Data, including clinical characteristics and computerised tomography (CT) examination results, were extracted from the hospital information system. High-resolution chest CT was performed using standardised protocols. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive model. Univariate analysis revealed significant differences in sex, age ≥ 60, patient delay, and CT findings (cavitation, consolidation, tree-in-bud sign, bronchial lesions, pleural effusion, lymphadenopathy, and pericardial effusion) between the two groups (P < 0.001). Multivariate logistic regression identified age ≥ 60 (odds ratio (OR) = 1.382), patient delay (OR = 1.830), cavitation (OR = 3.146), consolidation (OR = 2.077), tree-in-bud sign (OR = 2.764), and bronchial lesions (OR = 1.213) as independent risk factors for high infectiousness in patients with TB. The ROC curve analysis showed good discriminative ability, with an area under the curve of 0.71 (95% CI, 0.7–0.72). Age ≥ 60, patient delay, cavitation, consolidation, tree-in-bud sign, and bronchial lesions can effectively predict the high infectiousness of patients with TB, aiding in early screening and isolation measures to reduce the risk of TB transmission within hospitals.