A severity-of-illness score in patients with tuberculosis requiring intensive care

Lalla, Usha; Irusen, E M; Allwood, Brian; Taljaard, Jantjie; Koegelenberg, Coenraad F. N.

doi:10.7196/samj.2021.v111i3.14609

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…Predictors of hospital mortality were age, high APACHE IV score, mechanical ventilation, vasopressor therapy, RRT and hypoalbuminemia. Hypoalbuminemia is likely reflective of the inflammatory state of acute TB infection or underlying poor nutritional status 5 11 33–38. Like published cohorts, requirement for mechanical ventilation, vasopressor and RRT was associated with lower survival 4 39 40.…”

Section: Discussionmentioning

confidence: 83%

Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis (2008–2018)

Ling

Zhang

et al. 2022

Thorax

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BackgroundTuberculosis (TB) is a preventable and curable disease, but mortality remains high among those who develop sepsis and critical illness from TB.MethodsThis was a population-based, multicentre retrospective cohort study of patients admitted to all 15 publicly funded Hong Kong adult intensive care units (ICUs) between 1 April 2008 and 31 March 2019. 940 adult critically ill patients with at least one positive Mycobacterium tuberculosis (MTB) culture were identified out of 133 858 ICU admissions. Generalised linear modelling was used to determine the impact of delay in TB treatment on hospital mortality. Trend of annual Acute Physiology and Chronic Health Evaluation (APACHE) IV-adjusted standardised mortality ratio (SMR) over the 11-year period was analysed by Mann-Kendall’s trend test.ResultsICU and hospital mortality were 24.7% (232/940) and 41.1% (386/940), respectively. Of those who died in the ICU, 22.8% (53/232) never received antituberculosis drugs. SMR for ICU patients with TB remained unchanged over the study period (Kendall’s τb=0.37, p=0.876). After adjustment for age, Charlson comorbidity index, APACHE IV, albumin, vasopressors, mechanical ventilation and renal replacement therapy, delayed TB treatment was directly associated with hospital mortality. In 302/940 (32.1%) of patients, TB could only be established from MTB cultures alone as Ziehl-Neelsen staining or PCR was either not performed or negative. Among this group, only 31.1% (94/302) had concurrent MTB PCR performed.ConclusionsSurvival of ICU patients with TB has not improved over the last decade and mortality remains high. Delay in TB treatment was associated with higher hospital mortality. Use of MTB PCR may improve diagnostic yield and facilitate early treatment.

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Section: Discussionmentioning

confidence: 83%

Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis (2008–2018)

Ling

Zhang

et al. 2022

Thorax

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“…The revised model was streamlined to four parameters: septic shock, immunosuppression, acute kidney injury, and lack of lobar consolidation. 12 However, both the development and validation sample sizes were small, and the model was not well-validated, further limiting its clinical application.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Although some researchers have attempted to develop predictive models for death in ICU patients with TB, the reliability and efficacy of these models have been questioned owing to the small sample sizes, wide variations in results, and the lack of further stratified analysis in some patients with SCAP. 11 , 12 Risk prediction models for mortality in PTB complicated by SCAP are rare. Therefore, the construction of a risk prediction model for mortality in PTB complicated by SCAP has significant clinical value for early prognostic evaluation, guiding clinical decision making and optimizing medical resource allocation.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Risk Mortality Prediction Model for Patients with Pulmonary Tuberculosis Complicated by Severe Community-Acquired Pneumonia in the Intensive Care Unit

Cui,

Mao,

Feng

et al. 2024

IDR

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Purpose The mortality rate from pulmonary tuberculosis (PTB) complicated by severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) remains high. We aimed to develop a rapid and simple model for the early assessment and stratification of prognosis in these patients. Patients and Methods All adult patients with PTB complicated by SCAP admitted to the ICU of a tertiary hospital in Chengdu, Sichuan, China between 2019 and 2021 (development cohort) and 2022 (validation cohort) were retrospectively included. Data on demographics, comorbidities, laboratory values, and interventions were collected. The outcome was the 28-day mortality. Stepwise backward multivariate Cox analysis was used to develop a mortality risk prediction score model. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the model’s predictive efficiency. Decision curve analysis (DCA) was used to validate the model’s clinical value and impact on decision making. Results Overall, 357 and 168 patients were included in the development and validation cohorts, respectively. The Pulmonary Tuberculosis Severity Index (PTSI) score included long-term use of glucocorticoid, body mass index (BMI) <18.5 kg/m 2 , diabetes, blood urea nitrogen (BUN) ≥7.14 mmol/L, PO 2 /FiO 2 <150 mmHg, and vasopressor use. The area under the ROC curve (AUC) values were 0.817 (95% CI: 0.772–0.863) and 0.814 for the development and validation cohorts, respectively. The PTSI score had a higher AUC than the APACHE II, SOFA, and CURB-65 score. The calibration curves indicated good calibration in both cohorts. The DCA of the PTSI score indicated the high clinical application of the model compared with the APACHE II and SOFA scores. Conclusion This prognostic tool was designed to rapidly evaluate the 28-day mortality risk in individuals with PTB complicated by SCAP. It can stratify this patient group into relevant risk categories, guide targeted interventions, and enhance clinical decision making, thereby optimizing patient care and improving outcomes.

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A severity-of-illness score in patients with tuberculosis requiring intensive care

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 2 publications

References 23 publications

Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis (2008–2018)

Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis (2008–2018)

Development and Validation of a Risk Mortality Prediction Model for Patients with Pulmonary Tuberculosis Complicated by Severe Community-Acquired Pneumonia in the Intensive Care Unit

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