Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure.
OBJECTIVE
To clarify the patterns of pulmonary tuberculosis (TB) that should result in a high index of suspicion, to increase the chances of early therapy and to identify predictors of 30-day mortality.


METHODS
Retrospective, 7-year study in two medical intensive care units (ICUs). All patients admitted with pulmonary TB were enrolled. Clinical and laboratory data at admission and events within 48 h of admission were collected. Predictors of 30-day mortality were identified by univariate and multivariate analysis.


RESULTS
The study included 99 patients with a median age of 41 years. Immunodeficiency was present in 60 patients, including 38 with AIDS. Fifty-nine patients had pulmonary TB alone, 22 also had extrapulmonary TB and 18 had miliary. All 99 patients were admitted for acute respiratory failure, some also with shock (20), neurologic disorders (18) or acute renal failure (10). Mechanical ventilation was needed in 50 patients; 22 patients met criteria for acute respiratory distress syndrome (ARDS). The 30-day mortality rate was 26.2%. Four factors independently predicted mortality: a time from symptom onset to treatment of more than 1 month (OR, 3.49; CI, 1.20-10.20), the number of organ failures (OR, 3.15; CI, 1.76-5.76), a serum albumin level above 20 g/l (OR, 3.96; CI, 1.04-15.10), and a larger number of lobes involved on chest radiograph (OR, 1.83; CI, 1.12-2.98).


CONCLUSIONS
Delayed clinical suspicion and treatment of active pulmonary TB with respiratory failure may contribute to the persistently high mortality rates in ICU patients with these diseases.
Zahar
J R
JR
Intensive Care Department, Bichat Claude-Bernard Hospital, University Paris 7, 46 rue Henri Huchard, 75018 Paris, France. JRZahar@hotmail.com
Azoulay
E
E
Klement
E
E
De Lassence
A
A
Lucet
J C
JC
Regnier
B
B
Schlemmer
B
B
Bedos
J P
JP
D000208:Acute Disease; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000382:microbiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*
D000995:Antitubercular Agents; D012709:Serum Albumin