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Review ArticleSystematic Review

Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis

Valliappan Muthu, Ritesh Agarwal, Sahajal Dhooria, Ashutosh N Aggarwal, Digambar Behera and Inderpaul Singh Sehgal
Respiratory Care December 2018, 63 (12) 1541-1554; DOI: https://doi.org/10.4187/respcare.06190
Valliappan Muthu
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Ritesh Agarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Sahajal Dhooria
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Ashutosh N Aggarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Digambar Behera
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Inderpaul Singh Sehgal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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  • For correspondence: inderpgi@outlook.com
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Abstract

BACKGROUND: The outcomes of patients with tuberculosis admitted to an ICU remain undetermined. Herein, we reviewed the literature to describe the mortality of subjects with tuberculosis who are critically ill, and explore the effect of glucocorticoids on survival.

METHODS: A systematic review of medical literature databases was performed for studies that describe the outcome of subjects with tuberculosis who required ICU admission. We calculated the proportion of hospitalized subjects with tuberculosis who required ICU admission. Pooled estimates of ICU and hospital mortality, and tuberculosis-related ARDS were calculated. We also studied the effect of systemic glucocorticoids on survival of subjects with tuberculosis who were critically ill.

RESULTS: A total of 35 studies (N = 1,815) were included. The pooled proportion of hospitalized subjects with tuberculosis who required ICU admission was 3.4% (95% CI 1.6–5.7%). The pooled ICU and hospital mortality was 48% (95% CI 41–55%) and 54% (95% CI 46–62%), respectively. Tuberculosis-related ARDS was associated with higher odds (odds ratio 3.88, 95% CI 1.73–8.72) of death. The use of glucocorticoids was not related to an improvement in survival (odds ratio 0.65, 95% CI 0.27–1.57).

CONCLUSIONS: Tuberculosis is a rare cause of ICU admission but is associated with high mortality. Tuberculosis-related ARDS is also associated with lower survival. The role of glucocorticoids in patients with tuberculosis who are critically ill remains unclear and needs further evaluation.

  • tuberculosis
  • intensive care
  • acute lung injury
  • acute respiratory distress syndrome
  • steroids

Footnotes

  • Correspondence: Inderpaul Singh Sehgal MD, DM, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, sector 12, Chandigarh, India 160012. E-mail: inderpgi{at}outlook.com.
  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2018 by Daedalus Enterprises
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Respiratory Care: 63 (12)
Respiratory Care
Vol. 63, Issue 12
1 Dec 2018
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Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis
Valliappan Muthu, Ritesh Agarwal, Sahajal Dhooria, Ashutosh N Aggarwal, Digambar Behera, Inderpaul Singh Sehgal
Respiratory Care Dec 2018, 63 (12) 1541-1554; DOI: 10.4187/respcare.06190

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Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis
Valliappan Muthu, Ritesh Agarwal, Sahajal Dhooria, Ashutosh N Aggarwal, Digambar Behera, Inderpaul Singh Sehgal
Respiratory Care Dec 2018, 63 (12) 1541-1554; DOI: 10.4187/respcare.06190
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Keywords

  • tuberculosis
  • intensive care
  • acute lung injury
  • acute respiratory distress syndrome
  • steroids

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