Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV

Ferreira, Márcia M. C.; Neves, Cynthia Pessoa; Souza, Alexandra B.; Beraldi-Magalhães, Francisco; Migliori, Giovanni Battista; Kritski, Afrânio Lineu; Cordeiro-Santos, Marcelo

doi:10.1590/s1806-37562017000000316

Cited by 26 publications

(30 citation statements)

References 30 publications

(39 reference statements)

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“…Tuberculosis was highly prevalent in HIV/AIDS patients admitted at the FMT-HVD, as has been occurring for the past ten years 5 . The prevalence of HIV/AIDS co-infection can be much higher, since TB is generally paucibacillary in HIV-infected individuals, which makes diagnosis di cult 7,20 . As the HIV infection weakens the host's immune response to TB, HIV/TB co-infection results in a more dramatic progression 7,16,17,20−22 .…”

Section: Discussionmentioning

confidence: 99%

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

Mota

Almeida

Santos

et al. 2020

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Background: While antiretroviral therapy (ART) has significantly improved survival rates of people living with HIV, some regions in Brazil still show a linear trend of growth in the opportunistic infections that cause HIV-associated mortality. We aimed to describe HIV-associated morbidity and mortality among hospitalized medical patients in a tertiary care hospital in Manaus, in the Brazilian Amazon, by investigating clinical data and immunologic biomarkers in order to assess predictive factors of mortality in this patient group. Methods: We prospectively measured concentrations of cytokines Th1/Th2/Th17 and soluble CD14 (sCD14) and reviewed the laboratory parameters and opportunistic infections in outcomes of either death or discharge of eighty-three HIV/AIDS patients who were admitted in 2017-2018 to the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus. Results: The mortality in the sample studied was 20.5%. Tuberculosis (TB) showed a relative risk (RR) =1.86 (confidence interval (CI) 1.14 to 2.81: and p = 0.026), and weight loss was the symptom (RR=1.81; CI: 1.21 to 2.53 and p = 0.007) most highly associated with the death outcome in HIV/AIDS inpatients. Univariable analyses showed that the eosinophil count, platelet distribution width (PDW), and alanine aminotransferase were the only laboratory parameters that differed among patients who died. In relation to cytokines and sCD14 levels, no differences were found between those who died or were discharged. A multivariable logistic regression model was used to predict mortality and showed that individuals with no digestive syndrome (especially the absence of oropharyngeal candidiasis), nor TB are 63% to 76% less likely to die, respectively. In addition, increases in PDW values also decreased the probability of death. Curiously, patients who were discharged showed a trend towards a concomitant increase in PDW and mean platelet volume (MPV) in relation to those who died.Conclusions: Opportunistic infections continue to be major events in morbidity and mortality of HIV/AIDS patients, and the relationship between increased PDW and the likelihood of survival suggests the need for future studies on innate immune response of platelets in HIV/AIDS inpatients.

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Section: Discussionmentioning

confidence: 99%

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

Mota

Almeida

Santos

et al. 2020

Preprint

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“…38 Thus, the most common indication for TB-related ICU admission is acute respiratory failure or multiorgan failure; however, often, these complications may not be directly related to TB. [38][39][40][41][42] Other potential indications for ICU admission are massive hemoptysis, cardiogenic shock, and neurological deterioration in patients with tuberculous meningitis. 38,[43][44][45] Thus, there are no data specifically on TB CAP and outcomes in the ICU; this is an area that warrants further study.…”

Section: Clinical Presentationmentioning

confidence: 99%

The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

Dheda

Makambwa

Esmail

2020

Semin Respir Crit Care Med

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AbstractAccording to World Health Organization estimates, tuberculosis (TB) and lower respiratory tract infections (LRTIs) are both among the top 10 global causes of death. TB and community-acquired pneumonia (CAP), if mortality estimates are combined, would rank as the third most common cause of death globally. It is estimated that each year there are approximately 10 million new cases of TB that are associated with approximately 1.2 million deaths, and almost 450 million new episodes of LRTI (synonymous with CAP) with approximately 4 million associated deaths. Globally, Streptococcus pneumoniae remains the most common cause of CAP. However, although well documented, it is not widely appreciated that in several parts of the world, including sub-Saharan Africa, Asia, and South America, Mycobacterium tuberculosis is an important cause of CAP, if not the most common organism isolated in such settings. Thus, CAP due to M. tuberculosis is not uncommon in some parts of the world with up to a third of cases being attributable to M. tuberculosis. Consequently, TB remains an important clinical entity in the intensive care unit in these settings. Despite its frequency and importance, there are very limited data about TB CAP. In this review we discussed the epidemiology, immunopathogenesis, clinical presentation, diagnosis, management, prognosis, and prevention of TB CAP. The utility of newer diagnostic approaches is highlighted.

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“…An increasing proportion (3-16%) of patients diagnosed with active tuberculosis (TB) require intensive care [1][2][3]. In countries with high TB and human immunodeficiency virus (HIV) burden [i.e.…”

Section: Introductionmentioning

confidence: 99%

“…In countries with high TB and human immunodeficiency virus (HIV) burden [i.e. Brazil], TB/HIV co-infection accounts between 69 and 93% of TB cases admitted at an intensive care unit (ICU), usually associated with acute respiratory failure (ARF) and mechanical ventilation (MV) [3,4]. Patients with TB admitted to the ICU have a poor prognosis and are associated with increasing costs for the health system when compared to a patient with uncomplicated TB [5,6].…”

Section: Introductionmentioning

confidence: 99%

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

et al. 2020

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Background: The detection of Mycobacterium tuberculosis (MTB) in the intensive care unit (ICU) presents several challenges, mainly associated to the clinical state of the patient. The presence of HIV infection further aggravates this scenario, requiring a reliable collection method, with better performance in the microbiological/molecular techniques to be used. We evaluated the performance of two methods for sample collection, mini bronchoalveolar lavage (Mini-BAL) and endotracheal aspirate (ETA), for diagnosis of pulmonary tuberculosis (PTB) in critically ill patients.Methods: This prospective study involved 26 HIV positive ICU internalized patients, with presumptive PTB who required mechanical ventilation. Two samples were obtained prospectively from 26 HIV ICU patients with presumptive PTB by Mini-BAL and ETA. The samples were processed for smear microscopy, Löwenstein-Jensen medium and the BACTEC Mycobacteria Growth Indicator Tube 960 system®. We define as confirmed PTB patients with positive MTB culture. Furthermore, all samples obtained through the Mini-BAL were analyzed by Xpert® MTB/RIF. Results: Our results demonstrated that the respiratory samples obtained by Mini-BAL were able to increase MTB detection in critically ill patients with presumptive PTB. The Mini-BAL allowed 30% increased recovery and guaranteed enough sample volume for processing in all methods. In addition, the larger volume of the samples obtained with this technique enabled the Xpert® MTB/RIF molecular test for diagnosis of TB. Conclusions:The Mini-BAL showed be an acceptable alternative to ETA in this population, since these critically ill and often-immunocompromised patients are more likely to develop complications related to invasive procedures.

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Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV

Cited by 26 publications

References 30 publications

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

The role of mini-bronchoalveolar lavage fluid in the diagnosis of pulmonary tuberculosis in critically ill patients

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