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Clinical Profile and Outcome of Critically Ill Patients with Tuberculosis

Authors
  • Thomas, Lovely1
  • Chacko, Binila1
  • Jupudi, Samuel1
  • Mathuram, Alice2
  • George, Tina3
  • Gunasekaran, Karthik4
  • Rajan, Sudha J5
  • Carey, Ronald AB6
  • Peter, John V1
  • 1 Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • 2 Department of Medicine 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • 3 Department of Medicine 2, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • 4 Department of Medicine 5, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • 5 Department of Medicine 3, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
  • 6 Department of Medicine 4, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
Type
Published Article
Journal
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
Publisher
Jaypee Brothers Medical Publishers
Publication Date
Jan 01, 2021
Volume
25
Issue
1
Pages
21–28
Identifiers
DOI: 10.5005/jp-journals-10071-23503
PMID: 33603297
PMCID: PMC7874288
Source
PubMed Central
Keywords
License
Green

Abstract

Aim and objective Although studies have described the clinical profile of patients admitted to the intensive care unit (ICU) with tuberculosis, it is unclear if the type of tuberculosis (pulmonary, extrapulmonary, or disseminated) impacts outcome. Matrials and methods Demographic data, microbiology, treatment, and outcomes over 5 years (2012–16) were obtained from electronic records. Patients were categorized as pulmonary, extrapulmonary, or disseminated tuberculosis. Comparisons were done using t test and Fisher's exact test as appropriate. Predictors of outcome were explored using bivariate and multivariate logistic regression analysis and expressed as odds ratio (OR) with 95% confidence intervals (CI). Results Of the 428 ICU admissions with suspected tuberculosis, 212 (121 male) patients with mean (standard deviation) age of 41.9 (16.7) years and APACHE-II score of 20.8 (6.6) were diagnosed as pulmonary ( n = 55) and extrapulmonary ( n = 52) or disseminated tuberculosis ( n = 105). In 50.5%, the diagnosis of tuberculosis was established during the current ICU admission when they presented with organ dysfunction. Overall, microbiological confirmation was possible in 75.5%; 14 (10.3%) isolates were Rifampicin resistant. ICU admission was required primarily for ventilation ( n = 176; 83%) and hemodynamic instability ( n = 67; 32%). Hospital mortality was 50%. Outcomes were similar in the three groups except for longer duration of stay ( p value = 0.04) in disseminated tuberculosis. On multivariate logistic regression analysis, pulmonary tuberculosis (OR 2.83; 95% CI 1.15–6.95) and vasoactive treatment (OR 15.8; 95% CI 6.4–39.2) were independently associated with death; need for ventilation predicted mortality perfectly. Conclusion In this cohort of patients admitted to ICU with tuberculosis, 50% were newly diagnosed during ICU admission. Pulmonary site of involvement and need for organ support are independent risk factors for death. How to cite this article Thomas L, Chacko B, Jupudi S, Mathuram A, George T, Gunasekaran K, et al. Clinical Profile and Outcome of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2021;25(1):21–28.

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