Nutritional and Biochemical Correlates of Disease Severity and Hospitalization in Adults with Drug-resistant Tuberculosis: A Prospective Study from North India

BACKGROUND: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in high-burden countries. While microbiological diagnosis is central to management, factors determining disease severity and hospitalization at presentation are less well characterized, particularly simple clinical and biochemical markers that may aid early risk stratification. OBJECTIVES: To evaluate the clinical, nutritional, radiological, and biochemical profile of adults with confirmed DR-TB and to identify factors associated with disease severity, bacillary burden, and hospitalization. METHODS: This prospective observational study enrolled adults (>14 years) with confirmed DR-TB treated at a tertiary care DR-TB center in New Delhi between April and December 2022. Demographic, clinical, nutritional, biochemical, radiological, and microbiological data were collected at baseline. Disease severity was assessed using chest radiograph extent and sputum smear grading. Associations were analyzed using correlation and comparative statistical methods. RESULTS: A total of 55 patients were included (mean age: 26.6 ± 13.3 years), with a female predominance (52.7%). Undernutrition was common, with a mean body mass index of 17.3 ± 2.7 kg/m2 and 63.6% of patients underweight. Greater radiographic severity correlated with lower body mass index (BMI), higher symptom burden, and higher sputum smear grades (P < 0.01). Elevated alkaline phosphatase (ALP) levels were consistently associated with cough severity, dyspnea, radiographic extent, higher smear grades, and need for hospitalization. Lower serum protein and magnesium levels were associated with higher bacillary burden. Nearly half of the patients (47.3%) required hospitalization at diagnosis, which was significantly associated with lower BMI, hypoproteinemia, and elevated ALP levels. CONCLUSION: In adults with DR-TB, disease severity and hospitalization at presentation are closely associated with nutritional depletion and biochemical derangements in addition to microbiological burden. Simple, routinely available parameters such as BMI, serum protein, ALP, and magnesium may help identify high-risk patients early and support triage and management decisions in resource-limited settings.