Clinical Presentation and Outcome of Active Pulmonary Tuberculosis patients requiring Respiratory Intensive Care admission

Abstract

Pulmonary TB requiring ICU care is rare accounting to 1-3% of all TB cases, but commonly known to be of markedly bad prognosis. Up to our knowledge this was the first Egyptian study to deal with active pulmonary tuberculosis inside ICU. This study aimed to describe and determine the clinical presentation, mortality rate and risk factors associated with mortality in patients with active pulmonary tuberculosis requiring Respiratory ICU admission. This was a retrospective-prospective study design started in January 2011 in which adult patients (> 16 years) with active pulmonary TB previously or subsequently admitted to the Respiratory ICU (RICU) of Abbassia Chest Hospital between January 2009 to December 2010 (retrospective part) and between January 2011 to December 2011 (prospective part) respectively were included. Patients who stay or stayed at RICU less than 24 hours or presenting with inactive pulmonary TB or extrapulmonary TB were excluded. TB treatment in the hospital is according to WHO and national guidelines. Demographic, clinical, radiological and therapeutics characteristics were obtained from the medical records. A total of 100 patients were included (retrospective part included 60 patients and prospective part included 40 patients). Of 100 patients studied, 74 (74%) died during ICU stay. The results of our study revealed that the median age of all patients was 38 years. Males outnumbered females, especially among the survivors. Liver impairment (48%) was the most common comorbidity. Three of the 100 patients were positive for HIV infection. There was a significant difference between survivors and non-survivors regarding female sex, far advanced lesion, type of respiratory failure, APACHE II score, GCS, mechanical ventilation, electrolyte disturbances as a recorded complication occurred in the ICU, urea, creatinine, total bilirubin, albumin and TLC levels, PH of the blood, oxygen saturation and anti-TB treatment drug regimens and duration of administration of anti-TB drugs.

By studynig different involved factors, Pneumonia pattern, female sex, far advanced lesion (by radiology) and renal impairment were found to be a significant model for risk factors for non-survival. On searching for predictors of mortality by studying different involved factors, Mechanical ventilation was the only predictor of non-survival with diagnostic accuracy 85%.