Objective The aim of this study was to clarify the association between nutritional state on admission and in-hospital death in tuberculosis (TB) patients, including a high proportion of elderly patients. Methods A retrospective cohort study of 246 TB patients was conducted. The serum albumin concentra-tions and peripheral blood lymphocyte counts were measured on admission, and the primary outcome of in-terest was in-hospital death. Patient mortality was categorized into two groups: TB death and non-TB death. A multivariate analysis was performed to evaluate the relationship between nutritional state on admission and in-hospital mortality in TB patients. Results The median [interquartile range] patient age was 79 [69-83] years, and the in-hospital death rate was 20.73% (TB death: 26 patients; non-TB death: 25 patients). The multivariate analysis revealed that the serum albumin concentrations (OR: 0.21, 95% CI: 0.10-0.41; p<0.0001) and peripheral blood total lympho-cyte counts (Category 2 [627.2-1, 106.7/mm3] vs. 1 [<627.2/mm3]. OR: 0.28, 95% CI: 0.11-0.73; p=0.009, Category 3 [>1, 106.7/mm3] vs. 1. OR: 0.24, 95% CI: 0.08-0.76, p=0.015) on admission were significantly as-sociated with all in-hospital deaths in the TB patients. The serum albumin concentrations and peripheral blood total lymphocyte counts were also found to be associated with in-hospital deaths directly caused by TB. Conclusion Hypoalbuminemia and lymphocytopenia on admission are predictive risk factors for in-hospital mortality in TB patients. Nutritional defects should thus receive special attention in order to reduce TB pa-tient mortality, particularly among elderly patients.