Clinical characteristics and risk factors of severe pulmonary tuberculosis in children in Yunnan, China

Severe pulmonary tuberculosis (PTB) drives treatment failure and poor prognosis, analyzing clinical characteristics and risk factors in children is key to early recognition and improving outcomes. A single-center retrospective cohort study of children with PTB in Yunnan, China (2014–2024), investigated clinical characteristics and risk factors of severe PTB. A total of 431 PTB children were enrolled, 58.5% were male, median age of 5.75 years (Q1–Q3: 1.57–10.35). 142 cases (32.9%) were diagnosed as severe PTB, most prevalent in 1–4 years group. Clinically, Severe PTB most commonly complicated tuberculous meningitis (TBM) (54 cases, 38.0%) and the proportion of patients with prolonged fever was higher (> 30 days:31.3%vs8.8%). Radiological findings were predominantly exudative and infiltrative lesions (316 cases,73.3%). Seven variable features were identified through the LASSO regression. Multivariate analysis revealed that abdominal pain, and central nervous system symptoms were associated with increased risk of severe PTB. In contrast, cough and chest imaging of pleural thickening and/or effusion were not elevated risk. Bacillus Calmette-Guerin (BCG) vaccination and older age were protective factors. Logistic regression demonstrated good calibration and discrimination (AUC,0.802;95% CI: 0.756–0.847). These findings provide insights into early identification of high-risk children and development of targeted preventive and clinical strategies to improve outcomes in pediatric PTB.