Clinical and transcriptomic risk factors for post-tuberculosis lung disease in a cohort of Kenyan adults

RATIONALE: Post-tuberculosis lung disease (PTLD), which includes restrictive and obstructive patterns of impairment, develops in 50% or more of survivors of tuberculosis (TB), yet mechanisms and associated risk factors are poorly understood. OBJECTIVES: We sought to identify clinical and transcriptomic risk factors for PTLD phenotypes. METHODS: In a prospective, observational, cohort study, we enrolled adults (month 0) with newly diagnosed pulmonary TB in Nairobi, Kenya, and evaluated clinical and transcriptomic risk factors for PTLD. Participants completed 6 months of standard anti-TB therapy. PTLD was defined as abnormal spirometry at month 12 (ie, 6 months posttreatment) with either a restrictive or obstructive pattern. MEASUREMENTS AND MAIN RESULTS: We enrolled 205 participants, of whom 103 (50.2%) had PTLD, including 60 with restrictive PTLD and 43 obstructive PTLD. Participants with PTLD had lower mid-upper arm circumference (MUAC) and cough peak flow. In multivariable analyses, having more lung quadrants involved on radiograph at diagnosis was a risk factor for both restrictive PTLD (adjusted odds ratio [aOR], 2.1; P