Factors influencing development and mortality of acute respiratory failure in hospitalized patient with active pulmonary tuberculosis: a 10-year retrospective review

Abstract

Background: Pulmonary tuberculosis with acute respiratory failure is fatal and is a burden in the intensive care units and leads to mortality. This retrospective study identifies the factors influencing the development of pulmonary tuberculosis requiring mechanical ventilation (TBMV) and mortality in the hospitalized patients with pulmonary tuberculosis. Methods:The medical records of hospitalized adult patients with pulmonary tuberculosis were retrospectively reviewed. Demographic data, clinical presentations, radiographic findings, biochemical tests, and clinical outcomes were collected. Data were compared by Student's t-test and Chi-square test between groups. Select variables that were statistically significant with P values <0.1 were introduced into a forward, stepwise, logistic regression model. Odds ratios (ORs) and their 95% confidence intervals (CIs) identified the independent influencing factors in the development of TBMV and mortality.Results: Of 268 enrolled patients, 185 (69.0%) were male. The patients were equally divided between the TBMV and non-TBMV groups. The shorter duration of illness (OR, 0.99; 95% CI, 0.98-0.99), underlying disease of AIDS (OR, 14.55; 95% CI, 1.71-123.91), presentation of fever (OR, 2.11; 95% CI, 1.20-3.71) and dyspnea (OR, 3.51; 95% CI, 2.02-6.11), large amount of acid fast bacilli on sputum smear (OR, 3.76; 95% CI, 1.90-7.47), lower serum albumin level (OR, 0.39; 95% CI, 0.26-0.59), and delayed initiation of antituberculosis agents (OR, 1.06; 95% CI, 1.00-1.12) were independent factors to develop TBMV. Male gender (OR, 2.16; 95% CI, 1.01-4.61), consolidation pattern on chest X-ray (OR, 2.41; 95% CI, 1.17-4.98), and lower serum albumin (OR, 0.39; 95% CI, 0.21-0.71) were correlated to mortality. Conclusions:The incidence and mortality rate of TBMV patients were high. Acute tuberculous pneumonia, underlying disease of AIDS, amount of acid fast bacilli, and delayed administration of antituberculosis agents were independent risk factors to develop TBMV. Male gender, consolidation on chest X-ray, and low serum albumin were significantly related to mortality.

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

“…Of the included studies, 19 studies were from high tuberculosis burden countries. 2,3,[5][6][7]18,19,[22][23][24][26][27][28]31,35,37,39,42,43 One study each exclusively included subjects who were critically ill with chronic kidney disease 29 or with human immunodeficiency virus 42 and affected with tuberculosis. Six studies included only subjects with tuberculosis-related ARDS.…”

“…1,4,32 The high mortality could also reflect a referral bias with the sickest of patients getting admitted to ICU. 37 Finally, infection with Mycobacterium tuberculosis may suppress monocyte expression that causes a state of immunosuppression that could possibly increase the risk for secondary Fig. 4.…”

“…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).…”

In-hospital mortality of pulmonary tuberculosis with acute respiratory failure and related clinical risk factors

“…Acute respiratory failure caused by PTB is rare but PTB with complicated comorbidities and sepsis can lead to ARF and death. A variety of risk factors of PTB patients with ARF have been associated with in-hospital mortality, including male gender, elderly, consolidation on chest x-ray, secondary infection, low albumin and sepsis [7] , [9] , [10] , [11] . Underlying HIV infection were risk factors to develop severe disease but not to mortality [9] .…”

“…A variety of risk factors of PTB patients with ARF have been associated with in-hospital mortality, including male gender, elderly, consolidation on chest x-ray, secondary infection, low albumin and sepsis [7] , [9] , [10] , [11] . Underlying HIV infection were risk factors to develop severe disease but not to mortality [9] . Several predictive scoring systems such as National Early Warning Score 2 (NEWS2), quick Sequential Organ Failure Assessment (qSOFA) and CRB-65, also commonly used to identify in-hospital mortality but their accuracy in particular PTB patients with ARF were unknown [12] , [13] .…”