Department of Infection, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom; Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom.
Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherland; University of Groningen, University Medical Center Groningen, Tuberculosis center Beatrixoord, Haren, the Netherlands.
Pulmonology. 2022 Jul-Aug;28(4):297-309. doi: 10.1016/j.pulmoe.2022.01.016. Epub 2022 Feb 26.
Tuberculosis (TB) is associated with a high mortality in the intensive care unit (ICU), especially in subjects with Acute Respiratory Distress Syndrome (ARDS) requiring mechanical ventilation. Despite its global burden on morbidity and mortality, TB is an uncommon cause of ICU admission, however mortality is disproportionate to the advances in diagnosis and treatment made. Herein we report a systematic review of published studies.
Our Literature search was conducted to identify studies on outcomes of individuals with TB admitted to ICU. We report and review in-hospital mortality, predictors of poorer outcomes, usefulness of severity scoring systems and potential benefits of intravenous antibiotics. Searches from Pubmed, Embase, Cochrane and Medline were conducted from inception to March 2020. Only literature in English was included.
Out of 529 potentially relevant articles, 17 were included. Mortality across all studies ranged from 29-95% with an average of 52.9%. All severity scores underestimated average mortality. The most common indication for ICU admission was acute respiratory failure (36.3%). Negative predictors of outcome included hospital acquired infections, need of mechanical ventilation and vasopressors, delay in initiation of anti-TB treatment, more than one organ failure and a higher severity score. Low income, high incidence countries showed a 23.4% higher mortality rate compared to high income, low TB incidence countries.
Mortality in individuals with TB admitted to ICU is high. Earlier detection and treatment initiation is needed.
结核病（TB）与重症监护病房（ICU）的高死亡率相关，尤其是在需要机械通气的急性呼吸窘迫综合征（ARDS）患者中。尽管结核病在发病率和死亡率方面对全球造成了沉重负担，但它并不是 ICU 入住的常见原因，然而其死亡率与诊断和治疗的进步不成比例。在此，我们报告了一项已发表研究的系统评价。
我们的文献检索旨在确定入住 ICU 的结核病患者的结局研究。我们报告并回顾了院内死亡率、预后不良的预测因素、严重程度评分系统的有用性以及静脉抗生素的潜在益处。从 Pubmed、Embase、Cochrane 和 Medline 进行了从开始到 2020 年 3 月的搜索。仅纳入英文文献。
在 529 篇潜在相关文章中，有 17 篇被纳入。所有研究的死亡率范围为 29-95%，平均为 52.9%。所有严重程度评分均低估了平均死亡率。入住 ICU 的最常见指征是急性呼吸衰竭（36.3%）。预后不良的预测因素包括医院获得性感染、需要机械通气和血管加压药、开始抗结核治疗的延迟、超过一个器官衰竭和更高的严重程度评分。与高收入、低结核病发病率国家相比，低收入、高发病率国家的死亡率高 23.4%。
入住 ICU 的结核病患者死亡率较高。需要更早的发现和治疗启动。
