Factors Affecting Mortality in Critically Ill Patients With Tuberculosis: A Systematic Review and Meta-Analysis

Area of Science:

• Critical care medicine
• Infectious diseases
• Pulmonology

Background:

• Tuberculosis (TB) poses a significant mortality risk in critically ill patients.
• Identifying specific factors influencing outcomes in these patients is essential for improving care.

Purpose of the Study:

• To conduct a meta-analysis identifying factors associated with mortality in critically ill patients with tuberculosis.
• To inform focused treatment strategies for high-risk TB patients in intensive care units (ICUs).

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Embase, Cochrane Library, Google Scholar).
• Included studies compared mortality factors between survivors and non-survivors in critically ill TB patients.
• Seventeen studies were included in the final meta-analysis out of 3017 initial records.

Main Results:

• Major mortality predictors identified include advanced age, low platelet count, hypoalbuminemia, and elevated C-reactive protein (CRP).
• Requirement and duration of invasive mechanical ventilation, low PaO2/FiO2 ratio, acute respiratory distress syndrome (ARDS), and shock were significant factors.
• Hospital-acquired infections, renal replacement therapy, and extended ICU length of stay (LOS) also correlated with increased mortality.

Conclusions:

• Patient age, platelet count, albumin, and CRP levels are key indicators of mortality risk.
• Mechanical ventilation parameters, respiratory support (PaO2/FiO2 ratio), ARDS, shock, infections, and renal support significantly impact survival.
• ICU length of stay (LOS) is a critical factor associated with mortality in critically ill tuberculosis patients.