AI Article Synopsis
- - This study examined the outcomes of 940 critically ill patients with tuberculosis (TB) admitted to ICUs in Hong Kong over an 11-year period, finding high mortality rates of 24.7% in ICUs and 41.1% in hospitals, with a significant portion of ICU deaths occurring in patients who did not receive TB treatment.
- - Researchers used methods like generalized linear modeling and analyzed mortality trends, concluding that delays in TB treatment are linked to increased hospital mortality, and they noted that diagnostic methods like MTB PCR were underutilized.
- - The results suggest that despite TB being preventable and treatable, survival rates for ICU patients have not improved, emphasizing the need for quicker diagnoses and treatment to enhance patient
Article Abstract
Background: Tuberculosis (TB) is a preventable and curable disease, but mortality remains high among those who develop sepsis and critical illness from TB.
Methods: This was a population-based, multicentre retrospective cohort study of patients admitted to all 15 publicly funded Hong Kong adult intensive care units (ICUs) between 1 April 2008 and 31 March 2019. 940 adult critically ill patients with at least one positive (MTB) culture were identified out of 133 858 ICU admissions. Generalised linear modelling was used to determine the impact of delay in TB treatment on hospital mortality. Trend of annual Acute Physiology and Chronic Health Evaluation (APACHE) IV-adjusted standardised mortality ratio (SMR) over the 11-year period was analysed by Mann-Kendall's trend test.
Results: ICU and hospital mortality were 24.7% (232/940) and 41.1% (386/940), respectively. Of those who died in the ICU, 22.8% (53/232) never received antituberculosis drugs. SMR for ICU patients with TB remained unchanged over the study period (Kendall's τb=0.37, p=0.876). After adjustment for age, Charlson comorbidity index, APACHE IV, albumin, vasopressors, mechanical ventilation and renal replacement therapy, delayed TB treatment was directly associated with hospital mortality. In 302/940 (32.1%) of patients, TB could only be established from MTB cultures alone as Ziehl-Neelsen staining or PCR was either not performed or negative. Among this group, only 31.1% (94/302) had concurrent MTB PCR performed.
Conclusions: Survival of ICU patients with TB has not improved over the last decade and mortality remains high. Delay in TB treatment was associated with higher hospital mortality. Use of MTB PCR may improve diagnostic yield and facilitate early treatment.
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| http://dx.doi.org/10.1136/thorax-2022-218868 | DOI Listing |
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