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Home / The International Journal of Tuberculosis and Lung Disease, Volume 18, Number 7

Tuberculosis in the intensive care unit: a prospective observational study

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SETTING

Data on the determinants of tuberculosis (TB) mortality in the intensive care unit (ICU) are scarce. OBJECTIVE

To describe factors influencing outcomes of patients admitted with TB requiring mechanical ventilation. DESIGN

All TB patients admitted to the ICU of an academic hospital in South Africa from January 2012 to May 2013 were enrolled. Disease severity was graded according to the Acute Physiology And Chronic Health Evaluation (APACHE II) score. Comorbid diagnoses, clinical features, radiological and laboratory investigations and outcomes were recorded. RESULTS

Of 83 patients (mean age 36.5 ± 12.9 years; 45 females; 44 human immunodeficiency virus [HIV] positive) admitted with pulmonary (n = 69) and/or extra-pulmonary (n = 37) TB, 39 died in the ICU (mortality 44.2%), and a further 10 died during hospitalisation (in-hospital mortality 59.0%). Few clinical parameters, special investigations or other ancillary tests predicted outcome. Only CD4 count <200 cells/mm3 in HIV-co-infected patients (P = 0.043) and absence of lobar consolidation (P = 0.018) were associated with ICU mortality, whereas a high APACHE II score (22.6 vs. 18.1, P = 0.016) and development of renal failure (P = 0.016) were associated with hospital mortality. CONCLUSION

The mortality of TB patients admitted to the ICU was extremely high. Very few parameters were associated with poor outcome, and no single parameter predicted both ICU and in-patient mortality.

Keywords: intensive care unit; mortality; tuberculosis

Document Type: Research Article

Affiliations: 1: Divisions of Pulmonology, Department of Medicine, University of Stellenbosch & Tygerberg Academic Hospital, Cape Town, Western Cape Province, South Africa 2: Infectious Diseases, Department of Medicine, University of Stellenbosch & Tygerberg Academic Hospital, Cape Town, Western Cape Province, South Africa

Publication date: 01 July 2014

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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