Characteristics of Active Tuberculosis Patients Requiring Intensive Care Monitoring and Factors Affecting Mortality

Abstract

BackgroundOne to three percent of cases of acute tuberculosis (TB) require monitoring in the intensive care unit (ICU). The purpose of this study is to establish and determine the mortality rate and discuss the causes of high mortality in these cases, and to evaluate the clinical and laboratory findings of TB patients admitted to the pulmonary ICU.MethodsThe data of patients admitted to the ICU of Yedikule Chest Diseases and Chest Surgery Education and Research Hospital due to active TB were retrospectively evaluated. Demographic characteristics, medical history, and clinical and laboratory findings were evaluated.ResultsThirty-five TB patients (27 males) with a median age of 47 years were included, of whom 20 died within 30 days (57%). The Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were significantly higher, and albumin and PaO2/FIO2 levels were significantly lower, and shock, multiple organ failure, the need for invasive mechanical ventilation and drug resistance were more common in the patients who died. The mortality risk was 7.58 times higher in the patients requiring invasive mechanical ventilation. The SOFA score alone was a significant risk factor affecting survival.ConclusionThe survival rate is low in cases of tuberculosis treated in an ICU. The predictors of mortality include the requirement of invasive mechanical ventilation and multiple organ failure. Another factor specific to TB patients is the presence of drug resistance, which should be taken seriously in countries where there is a high incidence of the disease. Finding new variables that can be established with new prospective studies may help to decrease the high mortality rate.

Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis

“…The mortality of subjects with tuberculosis who are critically ill varied from 17 to 67%. [1][2][3][5][6][7] The pooled ICU (26 studies [n ϭ 1,282]) 2,3,[5][6][7]18,19,[23][24][25][26]38,[40][41][42]44 and hospital mortality (23 studies [n ϭ 1,283]) 1,3,16,17,[20][21][22][23][24][25][26]28,31,33,[36][37][38][39][40][42][43][44] was 48% (95% CI 41-55%, I 2 ϭ 86.11%, P Ͻ .001) and 54% (95% CI 46 -62%, I 2 ϭ 92.58%, P Ͻ .001), respectively (Fig. 2).…”

The critically ill patient with tuberculosis in intensive care: Clinical presentations, management and infection control

“…18 Patients with TB admitted to a Portuguese intensive care unit required a high degree of organ support [mechanical ventilation (66.7%), vasopressors (35.9%), renal replacement therapy (7.7%), extracorporeal membrane oxygenation (5.1%)]. 19 The mortality of patients with confirmed TB requiring intensive care is high [up to 68.7% 11,20 ]. Several models to predict mortality have been published.…”

Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

“…Risk factors for mortality include ARDS, multiorgan failure, sepsis, mechanical ventilation, renal replacement therapy, a high Acute Physiology and Chronic Health Evaluation II score, and a high Sequential Organ Failure Assessment score 17 24 , 31 , 32 We find it interesting that diabetes and HIV have not been associated with increased mortality, possibly because they are overshadowed by the aforementioned risk factors 17 24 , 25 , 31 , 32 …”

“…Among tuberculosis patients requiring admission to the ICU, mortality is > 50%, ranging from 20% to 70% 15 17 , 31 , 32 Mortality is even higher among patients on mechanical ventilation, one study reporting a mortality rate of 80% in tuberculosis patients with ARDS who required mechanical ventilation 15 . Risk factors for mortality include ARDS, multiorgan failure, sepsis, mechanical ventilation, renal replacement therapy, a high Acute Physiology and Chronic Health Evaluation II score, and a high Sequential Organ Failure Assessment score 17 …”