The outcomes of patients with tuberculosis admitted to an ICU remain undetermined. Herein, we reviewed the literature to describe the mortality of subjects with tuberculosis who are critically ill, and explore the effect of glucocorticoids on survival.
METHODS:
A systematic review of medical literature databases was performed for studies that describe the outcome of subjects with tuberculosis who required ICU admission. We calculated the proportion of hospitalized subjects with tuberculosis who required ICU admission. Pooled estimates of ICU and hospital mortality, and tuberculosis-related ARDS were calculated. We also studied the effect of systemic glucocorticoids on survival of subjects with tuberculosis who were critically ill.
RESULTS:
A total of 35 studies (N = 1,815) were included. The pooled proportion of hospitalized subjects with tuberculosis who required ICU admission was 3.4% (95% CI 1.6–5.7%). The pooled ICU and hospital mortality was 48% (95% CI 41–55%) and 54% (95% CI 46–62%), respectively. Tuberculosis-related ARDS was associated with higher odds (odds ratio 3.88, 95% CI 1.73–8.72) of death. The use of glucocorticoids was not related to an improvement in survival (odds ratio 0.65, 95% CI 0.27–1.57).
CONCLUSIONS:
Tuberculosis is a rare cause of ICU admission but is associated with high mortality. Tuberculosis-related ARDS is also associated with lower survival. The role of glucocorticoids in patients with tuberculosis who are critically ill remains unclear and needs further evaluation.
PennerC, RobertsD, KunimotoD, ManfredaJ, LongR. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med, 1995; 151(3 Pt 1):867–872.
2.
SilvaDR, MenegottoDM, SchulzLF, GazzanaMB, DalcinPT. Mortality among patients with tuberculosis requiring intensive care: a retrospective cohort study. BMC Infect Dis, 2010; 10:54.
3.
BalkemaCA, IrusenEM, TaljaardJJ, KoegelenbergCF. Tuberculosis in the intensive care unit: a prospective observational study. Int J Tuberc Lung Dis, 2014; 18(7):824–830.
4.
BastosHN, OsórioNS, CastroAG, RamosA, CarvalhoT, MeiraL, et al. A Prediction Rule to Stratify Mortality Risk of Patients with Pulmonary Tuberculosis. PLoS One, 2016; 11(9):e0162797.
5.
DengW, YuM, MaH, HuLA, ChenG, WangY, 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.
6.
SharmaSK, MohanA, BangaA, SahaPK, GuntupalliKK. Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis. Int J Tuberc Lung Dis, 2006; 10(4):429–435.
7.
MuthuV, DhooriaS, AggarwalAN, BeheraD, SehgalIS, AgarwalR. Acute Respiratory Distress Syndrome Due To Tuberculosis in a Respiratory ICU Over a 16-Year Period. Crit Care Med, 2017; 45(10):e1087–e1090.
AgarwalR, GuptaD, AggarwalAN, BeheraD, JindalSK. Experience with ARDS caused by tuberculosis in a respiratory intensive care unit. Intensive Care Med, 2005; 31(9):1284–1287.
10.
CritchleyJA, YoungF, OrtonL, GarnerP. Corticosteroids for prevention of mortality in people with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis, 2013; 13(3):223–237.
11.
LiberatiA, AltmanDG, TetzlaffJ, MulrowC, GøtzschePC, IoannidisJP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med, 2009; 151(4):W65–W94.
12.
KmetLM, LeeRC, LSC. Standard quality assessment criteria for evaluating primary research papers from a variety of fields. 2004. Edmonton: Alberta Heritage foundation for medical research. www.ahfmr.ab.ca. Accessed February 14, 2018.
13.
DeeksJJ, HigginsJPT, AltmanDG. Analysing and presenting results. In: AldersonP, GreenS, HigginsJPT. editors. Cochrane reviewers' handbook 422 [updated Mar 2004]. Chichester, UK: John Wiley & Son; 2004; 68–139.
14.
EggerM, Davey SmithG, SchneiderM, MinderC. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997; 315(7109):629–634.
15.
BeggCB, MazumdarM. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994; 50(4):1088–1101.
FrameRN, JohnsonMC, EichenhornMS, BowerGC, PopovichJJr. Active tuberculosis in the medical intensive care unit: a 15-year retrospective analysis. Crit Care Med, 1987; 15(11):1012–1014.
18.
LevyH, KallenbachJM, FeldmanC, ThorburnJR, AbramowitzJA. Acute respiratory failure in active tuberculosis. Crit Care Med, 1987; 15(3):221–225.
19.
HayhurstDM, KussmanBD, PotgeiterPD. Acute Respiratory Failure due to Pulmonary Tuberculosis - A Five Year Analysis in an Intensive Care Unit. S Afr J Crit Care, 1994; 10(1):4–7.
ZaharJR, AzoulayE, KlementE, De LassenceA, LucetJC, RegnierB, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med, 2001; 27(3):513–520.
22.
HuiC, WuCL, ChanMC, KuoIT, ChiangCD. Features of severe pneumonia in patients with undiagnosed pulmonary tuberculosis in an intensive care unit. J Formos Med Assoc, 2003; 102(8):563–569.
23.
KimJY, ParkYB, KimYS, KangSB, ShinJW, ParkIW, et al. Miliary tuberculosis and acute respiratory distress syndrome. Int J Tuberc Lung Dis, 2003; 7(4):359–364.
24.
LeePL, JerngJS, ChangYL, ChenCF, HsuehPR, YuCJ, et al. Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation. Eur Respir J, 2003; 22(1):141–147.
25.
ErbesR, OettelK, RaffenbergM, MauchH, Schmidt-IoanasM, LodeH. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J, 2006; 27(6):1223–1228.
26.
RyuYJ, KohWJ, KangEH, SuhGY, ChungMP, KimH, et al. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology, 2007; 12(3):406–411.
27.
KimYJ, PackKM, JeongE, NaJO, OhYM, LeeSD, et al. Pulmonary tuberculosis with acute respiratory failure. Eur Respir J, 2008; 32(6):1625–1630.
28.
LinSM, WangTY, LiuWT, ChangCC, LinHC, LiuCY, et al. Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure. Int J Tuberc Lung Dis, 2009; 13(3):335–340.
29.
UlasliSS, UlubayG, ArslanNG, SezerS, AkcayS, EyubogluFO, et al. Characteristics and outcomes of end-stage renal disease patients with active tuberculosis followed in intensive care units. Saudi J Kidney Dis Transpl, 2009; 20(2):254–259.
30.
AlshimemeriAA, ArabiYM, Al-JahdaliH, OlayanA, Al HarbiO, MemishZ. Clinical presentation and outcome of patients diagnosed with active pulmonary tuberculosis in a large critical care unit. Crit Care Shock, 2011; 14(1):1–6.
31.
LeeK, KimJH, LeeJH, LeeWY, ParkMS, KimJY, et al. Acute respiratory distress syndrome caused by miliary tuberculosis: a multicentre survey in South Korea. Int J Tuberc Lung Dis, 2011; 15(8):1099–1103.
32.
ValadeS, RaskineL, AoutM, MalissinI, BrunP, DeyeN, 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(4):173–178.
33.
LanoixJP, GaudryS, FlicoteauxR, RuimyR, WolffM. Tuberculosis in the intensive care unit: a descriptive analysis in a low-burden country. Int J Tuberc Lung Dis, 2014; 18(5):581–587.
34.
MansourM, MadkourA, FoudaM. Outcome of active pulmonary tuberculosis patients requiring respiratory intensive care admission. Egypt J Bronchol, 2014; 8(2):79–86.
35.
CalligaroGL, TheronG, KhalfeyH, PeterJ, MeldauR, MatinyenyaB, et al. Burden of tuberculosis in intensive care units in Cape Town, South Africa, and assessment of the accuracy and effect on patient outcomes of the Xpert MTB/RIF test on tracheal aspirate samples for diagnosis of pulmonary tuberculosis: a prospective burden of disease study with a nested randomised controlled trial. Lancet Respir Med, 2015; 3(8):621–630.
36.
RollasK, KaraA, Ortac ErsoyNE, Ozmen SunerK, GulluMN, OcalS, et al. Acute tuberculosis in the intensive care unit. Turk J Med Sci, 2015; 45(4):882–887.
37.
BhurayanontachaiR, ManeenilK. Factors influencing development and mortality of acute respiratory failure in hospitalized patient with active pulmonary tuberculosis: a 10-year retrospective review. J Thorac Dis, 2016; 8(7):1721–1730.
38.
FilizKA, LeventD, EmelE, PelinU, TurkayA, AybukeK. Characteristics of Active Tuberculosis Patients Requiring Intensive Care Monitoring and Factors Affecting Mortality. Tuberc Respir Dis (Seoul), 2016; 79(3):158–164.
39.
KimS, KimH, KimWJ, LeeSJ, HongY, LeeHY, et al. Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation. Int J Tuberc Lung Dis, 2016; 20(4):524–529.
40.
LohWJ, YuY, LooCM, LowSY. Factors associated with mortality among patients with active pulmonary tuberculosis requiring intensive care. Singapore Med J, 2017; 58(11):656–659.
41.
MahmoudES, BaharoonSA, AlsafiE, Al-JahdalyH. 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(9):973–978.
42.
PecegoAC, AmancioRT, RibeiroC, MesquitaEC, MedeirosDM, CerbinoJ, et al. Six-month survival of critically ill patients with HIV-related disease and tuberculosis: a retrospective study. BMC Infect Dis, 2016; 16:270.
43.
YangJY, HanM, KohY, KimWS, SongJW, OhYM, et al. Effects of Corticosteroids on Critically Ill Pulmonary Tuberculosis Patients With Acute Respiratory Failure: A Propensity Analysis of Mortality. Clin Infect Dis, 2016; 63(11):1449–1455.
44.
DuroRP, Figueiredo DiasP, FerreiraAA, XerindaSM, Lima AlvesC, SarmentoAC, et al. Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis. Crit Care Res Pract, 2017; 2017:9535463.
45.
CooksonST, JarvisWR. Prevention of nosocomial transmission of Mycobacterium tuberculosis. Infect Dis Clin North Am, 1997; 11(2):385–409.
46.
WangCS, ChenHC, YangCJ, WangWY, ChongIW, HwangJJ, et al. The impact of age on the demographic, clinical, radiographic characteristics and treatment outcomes of pulmonary tuberculosis patients in Taiwan. Infection, 2008; 36(4):335–340.
47.
ShinnickTM, KingCH, QuinnFD. Molecular biology, virulence, and pathogenicity of mycobacteria. Am J Med Sci, 1995; 309(2):92–98.
48.
AgarwalR, GuptaD, HandaA, AggarwalAN. Noninvasive ventilation in ARDS caused by Mycobacterium tuberculosis: report of three cases and review of literature. Intensive Care Med, 2005; 31(12):1723–1724.
