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

Muthu, Valliappan; Agarwal, Ritesh; Dhooria, Sahajal; Aggarwal, Ashutosh N.; Behera, Digambar; Sehgal, Inderpaul Singh

doi:10.4187/respcare.06190

Cited by 17 publications

(26 citation statements)

References 42 publications

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“…In the study, the mortality rate appears to be consistent with what has been reported previously in another literature [5]. However, it was below what was reported in a meta-analysis of the outcome of critically ill subjects with TB (ICU: 48% (95% CI: 41–55) [13]. Although the mortality rate reported in the study appears low when compared to the meta study, the mortality rate of 27% is high when compared to other highly lethal acute diseases [14].…”

Section: Discussionsupporting

confidence: 89%

Risk factors for death in tuberculosis patients requiring ICU care

et al. 2021

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The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7–0.9) per 1 g/l and 1.1 (95% CI: 1.0–1.2) per 1 × 109/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.

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Section: Discussionsupporting

confidence: 89%

Risk factors for death in tuberculosis patients requiring ICU care

et al. 2021

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“…The coexistence of severe ARDS complicating miliary TB in pediatric patients makes our case series almost unique and really challenging for pediatric intensivists. Actually, a few retrospective studies, all carried out in eastern countries, have outlined the clinical characteristics and outcome of adult patients with ARDS caused by miliary TB; recently, a systematic review of critically ill adult patients with TB disease, including miliary ARDS, has been published . Moreover, this condition is even more uncommon in the pediatric field, especially in Europe, as reports investigating the clinical course and respiratory management strategies in infants and children are currently limited to few cases .…”

Section: Discussionmentioning

confidence: 99%

“…Actually, a few retrospective studies, all carried out in eastern countries, 3,11,12 have outlined the clinical characteristics and outcome of adult patients with ARDS caused by miliary TB; recently, a systematic review of critically ill adult patients with TB disease, including miliary ARDS, has been published. 21 Moreover, this condition is even more uncommon in the pediatric field, especially in Europe, as reports investigating the clinical course and respiratory management strategies in infants and children are currently limited to few cases. [22][23][24] In our experience, the use of rescue interventions in severe cases has been the only strategy to improve respiratory function and increase the chances of final clinical recovery.…”

Section: Patientmentioning

confidence: 99%

Miliary tuberculosis leading to acute respiratory distress syndrome: Clinical experience in pediatric intensive care

Piastra

Picconi

Morena

et al. 2019

Pediatric Pulmonology

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Acute respiratory distress syndrome (ARDS) represents a rare complication of miliary tuberculosis (TB) in the adult setting, and it is even less common in the pediatric population. The presence of comorbidities and the possibility of a delayed diagnosis may further impair the clinical prognosis of critically ill patients with disseminated TB and acute respiratory failure. In this report, we present a case series of five pediatric patients with miliary TB and ARDS, where rescue and multimodal respiratory support strategies have been applied with a favorable outcome in more than half of them. The burden of miliary TB over time on a general pediatric intensive care unit—including two ARDS patients—is also illustrated.

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“…Predictors of mortality in TB include APACHE II scores above 18. In intensive care unit patients, the number of organ failures, serum albumin below 20 g/l and a larger number of lobes involved on chest x-ray have been shown to increase mortality [ 4 ]. Signs and symptoms to assist in the diagnosis of TB have been well described, but atypical presentations abound.…”

Section: Discussionmentioning

confidence: 99%

“…Some patients may also rarely present with typical features of acute respiratory distress syndrome (ARDS). Mortality from ARDS secondary to TB is around 50% (95% CI: 43–57%) [ 4 ].…”

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confidence: 99%

Acute Respiratory Distress Syndrome in a Patient with Tuberculosis

Hallit

2020

Future Sci. OA

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Tuberculosis (TB) continues to be a major cause of death worldwide and can have varying manifestations. Acute respiratory distress syndrome (ARDS) is a rare complication of the clinical course of TB but carries a high mortality rate. We present a case of a diabetic African-American patient, with acute respiratory failure, rapidly progressing to ARDS secondary to TB, which had a fatal outcome. Clinicians should keep a high suspicion index for TB in the setting of ARDS since the use of empiric anti-TB treatment could potentially reduce mortality in these patients.

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

Abstract: Tuberculosis is a rare cause of ICU admission but is associated with high mortality. Tuberculosis-related ARDS is also associated with lower survival. The role of glucocorticoids in patients with tuberculosis who are critically ill remains unclear and needs further evaluation.

Cited by 17 publications

References 42 publications

Risk factors for death in tuberculosis patients requiring ICU care

Risk factors for death in tuberculosis patients requiring ICU care

Miliary tuberculosis leading to acute respiratory distress syndrome: Clinical experience in pediatric intensive care

Acute Respiratory Distress Syndrome in a Patient with Tuberculosis

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