Tuberc Respir Dis.  2010 May;68(5):259-266.

Clinical Characteristics and Prognostic Factors in Patients with Pulmonary Tuberculosis Admitted to Intensive Care Units

• Kang JY
• Kim MS
• Kim JS
• Kang HH
• Kim SS
• Kim YH
• Kim JW
• Lee SH
• Kim SC
• Moon HS

Abstract

BACKGROUND
Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality.
METHODS
From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed.
RESULTS
Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality.
CONCLUSION
Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.

Keyword

Tuberculosis, Pulmonary; Intensive Care; Nutritional Status; Respiratory Insufficiency

MeSH Terms

Anoxia
APACHE
Body Mass Index
C-Reactive Protein
Dyspnea
Hemoptysis
Hemorrhage
Hospital Mortality
Humans
Hypoalbuminemia
Critical Care
Intensive Care Units
Lymphopenia
Male
Malnutrition
Medical Records
Multivariate Analysis
Neurologic Manifestations
Nutritional Status
Respiration, Artificial
Respiratory Distress Syndrome, Adult
Respiratory Insufficiency
Retrospective Studies
Shock
Tuberculosis, Pulmonary
C-Reactive Protein

Figure

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  Figure 1 In-hospital survival curves by the Kaplan-Meier method.

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  Figure 2 Kaplan-Meier survival curves with a log-rank test, according to the absence (—) or presence (-----) of predictors of in-hospital mortality. (A) BMI <18, p=0.0085. (B) Albumin <2.5, p=0.0003. (C) Lymphocyte count <1,000/mm3, p=0.0001. (D) APACHE score ≥10, p=0.0016. (E) Respiratory failure, p<0.0001. BMI: body mass index; APACHE: acute physiology and chronic health evaluation.

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