Association between thymosin α1 therapy and 28-day mortality risk in critically ill patients with tuberculosis-related sepsis: a retrospective cohort study.
6 affiliations
- 1Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, 76# Linjiang Road, Yuzhong District, Chongqing, 400010, China.
- 2Department of Critical Care Medicine, Chongqing Public Health Medical Center, Chongqing, China.
- 3Department of Critical Care Medicine, Dazhou Central Hospital, Dazhou, China.
- 4Department of Critical Care Medicine, Chongqing Public Health Medical Center, Chongqing, China. [email protected].
- 5Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, 76# Linjiang Road, Yuzhong District, Chongqing, 400010, China. [email protected].
- 6Department of Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, 76# Linjiang Road, Yuzhong District, Chongqing, 400010, China. [email protected].
Abstract
Purpose
Patients with tuberculosis (TB)-related sepsis often experience profound immune dysregulation and poor clinical outcomes. Evidence of immunomodulatory therapeutic efficacy in this population remains limited. We evaluated the association between thymosin α1 (Tα1) use and 28-day all-cause mortality in critically ill TB-related sepsis patients and explored whether the strength of this association varied with the baseline lymphocyte count.Methods
This single-centre retrospective cohort study included critically ill, adult TB-related sepsis patients admitted to the intensive care unit (ICU) in 2017-2025. Exposure was any Tα1 use during ICU stay. The primary outcome was 28-day mortality. Association analyses included multivariable Cox regression, restricted mean survival time (RMST) analyses, and exploratory restricted cubic spline (RCS) modelling. Sensitivity analyses were performed.Results
Among 327 patients, 160 received Tα1 and 167 served as controls. Tα1 use was associated with a lower hazard of 28-day mortality after adjustment for baseline covariates (adjusted hazard ratio, 0.54; 95% confidence interval, 0.36-0.79; P = 0.002); sensitivity analyses showed estimates of similar direction. The proportional hazards assumption was violated; consequent RMST analysis revealed longer adjusted restricted mean survival in the Tα1 group. Exploratory RCS modelling suggested nonlinear variability in the association between Tα1 use and 28-day mortality across baseline lymphocyte counts, which appeared more pronounced at intermediate lymphocyte counts (approximately 0.8-1.2 × 10⁹/L); however, this data-driven pattern is hypothesis-generating.Conclusion
Among ICU patients with TB-related sepsis, Tα1 use was associated with lower observed 28-day mortality, but causality cannot be inferred. The identified variability in this association across baseline lymphocyte counts requires external validation.Clinical trial number
Not applicable.
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BibTeX
@article{wang2026association,
title = {{Association between thymosin α1 therapy and 28-day mortality risk in critically ill patients with tuberculosis-related sepsis: a retrospective cohort study.}},
author = {Tingting Wang and Shun Tan and Qiang Gao and Ya Dong Luo and Ping Yang and An Zhang},
journal = {BMC infectious diseases},
year = {2026},
month = aug,
doi = {10.1186/s12879-026-14132-6},
url = {https://europepmc.org/article/MED/42972235},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association between thymosin α1 therapy and 28-day mortality risk in critically ill patients with tuberculosis-related sepsis: a retrospective cohort study.
AU - Tingting Wang
AU - Shun Tan
AU - Qiang Gao
AU - Ya Dong Luo
AU - Ping Yang
AU - An Zhang
PY - 2026
DA - 2026/08/05
JO - BMC infectious diseases
DO - 10.1186/s12879-026-14132-6
UR - https://europepmc.org/article/MED/42972235
AB - Purpose Patients with tuberculosis (TB)-related sepsis often experience profound immune dysregulation and poor clinical outcomes. Evidence of immunomodulatory therapeutic efficacy in this population remains limited. We evaluated the association between thymosin α1 (Tα1) use and 28-day all-cause mortality in critically ill TB-related sepsis patients and explored whether the strength of this association varied with the baseline lymphocyte count.Methods This single-centre retrospective cohort study included critically ill, adult TB-related sepsis patients admitted to the intensive care unit (ICU) in 2017-2025. Exposure was any Tα1 use during ICU stay. The primary outcome was 28-day mortality. Association analyses included multivariable Cox regression, restricted mean survival time (RMST) analyses, and exploratory restricted cubic spline (RCS) modelling. Sensitivity analyses were performed.Results Among 327 patients, 160 received Tα1 and 167 served as controls. Tα1 use was associated with a lower hazard of 28-day mortality after adjustment for baseline covariates (adjusted hazard ratio, 0.54; 95% confidence interval, 0.36-0.79; P = 0.002); sensitivity analyses showed estimates of similar direction. The proportional hazards assumption was violated; consequent RMST analysis revealed longer adjusted restricted mean survival in the Tα1 group. Exploratory RCS modelling suggested nonlinear variability in the association between Tα1 use and 28-day mortality across baseline lymphocyte counts, which appeared more pronounced at intermediate lymphocyte counts (approximately 0.8-1.2 × 10⁹/L); however, this data-driven pattern is hypothesis-generating.Conclusion Among ICU patients with TB-related sepsis, Tα1 use was associated with lower observed 28-day mortality, but causality cannot be inferred. The identified variability in this association across baseline lymphocyte counts requires external validation.Clinical trial number Not applicable.
SN - 1471-2334
ER -