Tuberculosis in the intensive care unit: a prospective observational study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pulmonology

Background:

• Tuberculosis (TB) mortality data in intensive care units (ICUs) is limited.
• Understanding factors influencing outcomes for TB patients requiring mechanical ventilation is crucial.

Purpose of the Study:

• To identify determinants of mortality in TB patients admitted to the ICU.
• To describe factors associated with outcomes in mechanically ventilated TB patients.

Main Methods:

• Retrospective study of 83 TB patients admitted to an academic ICU in South Africa (2012-2013).
• Data collected included demographics, comorbidities (including HIV status), disease severity (APACHE II score), clinical features, and investigations.
• Outcomes assessed were ICU mortality and in-hospital mortality.

Main Results:

• Overall ICU mortality was 44.2% (39/83), with an in-hospital mortality of 59.0% (49/83).
• Low CD4 count (<200 cells/mm³) in HIV-co-infected patients and absence of lobar consolidation were associated with ICU mortality.
• High APACHE II scores and development of renal failure were linked to in-hospital mortality.

Conclusions:

• Tuberculosis patients admitted to the ICU face extremely high mortality rates.
• Few clinical or investigative parameters reliably predict outcomes in this population.
• No single factor effectively predicted both ICU and overall in-hospital mortality.