Quantitative assessment of functional disorders in patients with respiratory tuberculosis

Objective. To determine clinical parameters for assessing immune and respiratory dysfunction in patients with tuberculosis of the respiratory organs and, based on these parameters, develop rules for quantitative assessment of functional disorders using data mining methods.
Materials and methods. The study included 149 patients with respiratory tuberculosis, who were referred for the first time for medical and social examination to determine disability, and 75 patients in the control group who successfully completed the course of treatment. The study was conducted at the Minsk City Medical and Rehabilitation Expert Commission, the Minsk Regional Tuberculosis Dispensary, and the outpatient department of the Republican Scientific and Practical Center for Medical Technologies, Informatization, Management and Economics of Healthcare from 2017 to 2024. The mean age (SE) of patients in the study cohort was 47.4 (0.71) years.
Results. In the course of the conducted study, key clinical indicators determining the severity of immune and respiratory dysfunction in patients with tuberculosis of the respiratory organs were identified. The main predictor of the expert assessment of severe immune dysfunction was the clinical indicator of the presence of bacteria excretion (diagnostic accuracy of 90 %). The presence of bacteria excretion indicates the activity of the tuberculosis process and significant suppression of the immune system, which must be taken into account when determining the disability group. In the absence of bacteria excretion, the phase of the disease course is of decisive importance in assessing the severity of immune dysfunction: the resorption/consolidation phase correlates with moderate disorders, and the clinical cure phase – with mild disorders. The leading indicator for assessing the severity of respiratory dysfunction was the clinical indicator of blood oxygen saturation (SpO₂): a blood SpO2 level of more than 95 % correlates with minor respiratory dysfunction (accuracy of 88.6 %); a blood SpO₂ level of 92–94 % indicates mild respiratory impairment (accuracy 73.9 %). A clarifying criterion for assessing the severity of respiratory impairment is the forced expiratory volume in one second (FEV₁): a blood SpO₂ level of less than 92 % and an FEV1 value of less than 74 % of the predicted values indicate severe respiratory impairment (in 80 % of patients).
Сonclusion. The results obtained during the study have high practical significance for medical and social assessment and rehabilitation of patients with respiratory tuberculosis. The developed algorithms and criteria for assessing the severity of functional impairments, based on objective clinical and functional indicators, contribute to the standardization of expert decisions and increase their objectivity.

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