Citation Information :
Behera D, Prasad K, Aggarwal AN. Profile of Patients with Active Tuberculosis Admitted to a Respiratory Intensive Care Unit in a Tertiary Care Center of North India. Indian J Crit Care Med 2018; 22 (2):63-66.
Background: There is a paucity of literature regarding outcome of critically ill patients with tuberculosis (TB) from India. Herein, we describe our experience of patients with active TB admitted to a Respiratory Intensive Care Unit (RICU) of a tertiary care hospital.
Methods: This was a retrospective analysis of all the patients admitted with active TB. The baseline clinical, demographic, ICU parameters and mortality were recorded. A multivariate logistic regression analysis was performed to identify factors predicting mortality.
Results: A total 3630 patients were admitted to the ICU during the study period; of these, 63 (1.7%) patients (mean [standard deviation (SD)] age 37.3  years, 55.6% females) were admitted with active TB. Fifty-seven patients were mechanically ventilated (56, invasive and 1, noninvasive) for a mean (SD) duration of 7.5 (9.1) days. Respiratory failure was the most common indication for mechanical ventilation. TB-related acute respiratory distress syndrome was seen in 18 (28.6%) patients. There were 28 deaths (44.4%) during the study period. On a multivariate logistic regression analysis, a high baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) score (odds ratio [OR] [95 confidence interval (CI)], 1.12 [1.02–1.23]) and delta Sequential Organ Failure Assessment (SOFA) (OR [95 CI], 1.39 [1.00–1.94]) were the independent predictors of mortality.
Conclusion: TB was an uncommon cause of ICU admission even in a high TB burden country. Critically ill patients with TB had high mortality. A higher APACHE II score and delta SOFA were independent predictors of ICU mortality.
Penner C, Roberts D, Kunimoto D, Manfreda J, Long R. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med 1995;151:867-72.
Silva DR, Menegotto DM, Schulz LF, Gazzana MB, Dalcin PT. Mortality among patients with tuberculosis requiring intensive care: A retrospective cohort study. BMC Infect Dis 2010;10:54.
Balkema CA, Irusen EM, Taljaard JJ, Koegelenberg CF. Tuberculosis in the Intensive Care Unit: A prospective observational study. Int J Tuberc Lung Dis 2014;18:824-30.
Piqueras AR, Marruecos L, Artigas A, Rodriguez C. Miliary tuberculosis and adult respiratory distress syndrome. Intensive Care Med 1987;13:175-82.
Verdon R, Chevret S, Laissy JP, Wolff M. Tuberculous meningitis in adults: Review of 48 cases. Clin Infect Dis 1996;22:982-8.
Puri MM, Kumar S, Prakash B, Lokender K, Jaiswal A, Behera D, et al. Tuberculosis pneumonia as a primary cause of respiratory failure – Report of two cases. Indian J Tuberc 2010;57:41-7.
Agarwal MK, Muthuswamy PP, Banner AS, Shah RS, Addington WW. Respiratory failure in pulmonary tuberculosis. Chest 1977;72:605-9.
Kim S, Kim H, Kim WJ, Lee SJ, Hong Y, Lee HY, et al. Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation. Int J Tuberc Lung Dis 2016;20:524-9.
Muthu V, Dhooria S, Aggarwal AN, Behera D, Sehgal IS, Agarwal R, et al. Acute respiratory distress syndrome due to tuberculosis in a respiratory ICU over a 16-year period. Crit Care Med 2017;45:e1087-90.
Sharma SK, Mohan A, Banga A, Saha PK, Guntupalli KK. Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis. Int J Tuberc Lung Dis 2006;10:429-35.
Mahmoud ES, Baharoon SA, Alsafi E, Al-Jahdaly H. Acute respiratory distress syndrome complicating community-acquired pneumonia secondary to Mycobacterium tuberculosis in a tertiary care center in Saudi Arabia. Saudi Med J 2016;37:973-8.
Zahar JR, Azoulay E, Klement E, De Lassence A, Lucet JC, Regnier B, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med 2001;27:513-20.
Frame RN, Johnson MC, Eichenhorn MS, Bower GC, Popovich J Jr. Active tuberculosis in the medical Intensive Care Unit: A 15-year retrospective analysis. Crit Care Med 1987;15:1012-4.
Kim JY, Park YB, Kim YS, Kang SB, Shin JW, Park IW, et al. Miliary tuberculosis and acute respiratory distress syndrome. Int J Tuberc Lung Dis 2003;7:359-64.
Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H, et al. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J 2006;27:1223-8.
Valade S, Raskine L, Aout M, Malissin I, Brun P, Deye N, et al. Tuberculosis in the Intensive Care Unit: A retrospective descriptive cohort study with determination of a predictive fatality score. Can J Infect Dis Med Microbiol 2012;23:173-8.
Deng W, Yu M, Ma H, Hu LA, Chen G, Wang Y, et al. Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: A retrospective study in Chongqing, China. BMC Infect Dis 2012;12:121.
Agarwal R, Aggarwal AN, Gupta D. Role of noninvasive ventilation in acute lung injury/acute respiratory distress syndrome: A proportion meta-analysis. Respir Care 2010;55:1653-60.