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APACHE-II score for anti-tuberculosis tolerance in critically ill patients: a retrospective study
Junke Qiu1, Caihong Wang1, Xiaohong Pan1
1Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China.
Background:
To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment.
Methods:
This analysis included critically ill patients with tuberculosis. The utility of APACHE-II score for predicting drug withdrawal was evaluated using receiver operating characteristic (ROC) curve analysis.
Results:
Among 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn. The drug withdrawal group had higher APACHE-II score (median [interquartile range]: 21 [3-52] vs. 17 [4-42] points), higher CD4%, lower hemoglobin level, higher rates of chronic obstructive pulmonary disease (COPD) and chronic renal failure, and lower rate of extrapulmonary tuberculosis (P < 0.05). Logistic regression identified APACHE-II score > 18 (odds ratio [95% confidence interval]: 2.099 [1.321-3.334], P < 0.01), COPD (1.913 [1.028-3.561], P < 0.05) and hemoglobin level (0.987 [0.977-0.997], P < 0.05) as independent factors associated with drug withdrawal. At an optimal cutoff of 18.5, the sensitivity, specificity, positive predictive value and negative predictive value of APACHE-II score for predicting drug withdrawal was 59.2, 61.8, 56.9 and 64.1%, respectively.
Conclusions:
APACHE-II score > 18 points might predict patient tolerance of anti-tuberculosis treatment.
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