Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis

Abstract

Background. This study aims to describe the characteristics of tuberculosis (TB) patients requiring intensive care and to determine the in-hospital mortality and the associated predictive factors. Methods. Retrospective cohort study of all TB patients admitted to the ICU of the Infectious Diseases Department of Centro Hospitalar de São João (Porto, Portugal) between January 2007 and July 2014. Comorbid diagnoses, clinical features, radiological and laboratory investigations, and outcomes were reviewed. Univariate analysis was performed to identify risk factors for death. Results. We included 39 patients: median age was 52.0 years and 74.4% were male. Twenty-one patients (53.8%) died during hospital stay (15 in the ICU). The diagnosis of isolated pulmonary TB, a positive smear for acid-fast-bacilli and a positive PCR for Mycobacterium tuberculosis in patients of pulmonary disease, severe sepsis/septic shock, acute renal failure and Multiple Organ Dysfunction Syndrome on admission, the need for mechanical ventilation or vasopressor support, hospital acquired infection, use of adjunctive corticotherapy, smoking, and alcohol abuse were significantly associated with mortality (p < 0.05). Conclusion. This cohort of TB patients requiring intensive care presented a high mortality rate. Most risk factors for mortality were related to organ failure, but others could be attributed to delay in the diagnostic and therapeutic approach, important targets for intervention.

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

“…com). 1,5,6,18,21,[23][24][25]27,28,31,40,41,43,44 The common indications for the use of glucocorticoids were miliary tuberculosis, respiratory failure, ARDS, and shock. Eight studies compared mortality in subjects with and without glucocorticoids (Supplemental Table 2).…”

Tuberculosis septic shock, an elusive pathophysiology and hurdles in management: A case report and review of literature

“…In our immunocompetent patients, the clinical course worsened after the initiation of anti-TB medications. In Kethireddy et al [10] 's cases and other series [33] of critically ill TB patients, we were unable to retrieve any similar observations of exacerbation of TB induced sepsis after antibiotics administration. In HIV coinfection the entity of IRIS is well recognized [34] .…”

The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

“…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.…”

“…43 Mortality rates of 22 to 70% have been observed in TB-HIV co-infected patients admitted to the ICU. 41,42,47 In summary, risk factors associated with increased mortality in ICU (and not specifically due to TB CAP alone) include older age, mechanical ventilation, multiorgan failure, APACHE II score of >20, hemodynamic instability requiring vasopressors, nosocomial pneumonia, and delayed initiation of antituberculous treatment. 38,[43][44][45]47 In addition to the above risk factors, advanced immunosuppression, hypoalbuminemia, and lymphopenia are predictors of increased mortality in TB-HIV co-infected patients in the ICU.…”

“…38,[43][44][45]47 In addition to the above risk factors, advanced immunosuppression, hypoalbuminemia, and lymphopenia are predictors of increased mortality in TB-HIV co-infected patients in the ICU. 41,42,47 Diagnosis of TB CAP…”