Dynamic Biochemical Phenotypes in Hospitalized Patients with Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) produces systemic alterations that can be reflected in biochemical parameters beyond microbiological resolution. Early characterization of the biochemical response to treatment could provide additional criteria for following up with hospitalized patients. A retrospective observational study was conducted focusing on patients with pulmonary TB from a tertiary care hospital, based on biochemical parameters upon admission (“before”) and between 2 and 10 days after starting anti-tuberculosis treatment (“after”). The patients were grouped into three clusters according to the results of the clinical tests: mild (70.1%), inflammatory (26.7%), and severe (3.2%). After the start of treatment, 30% of the patients migrated toward the most biochemically compromised phenotype (Cluster 3). Sixty-one percent showed deterioration in at least one of the three key parameters; only 12.8% improved simultaneously. Significant associations were identified between unfavorable biochemical evolution and HIV (p = 0.004) or patients with public health coverage (p = 0.01). Overall, after antituberculous therapy, a reduction in CRP and leukocytes was observed (p < 0.001), and progressive anemia (ΔHb: −1.7 g/dL) and renal deterioration (ΔCr: +0.52 mg/dL) were identified. The identification of dynamic phenotypes in patients with pulmonary TB can be used to establish early risk markers and contribute to individualized clinical surveillance.