Sieow N Y F, Goh J T K, Gokhale R S, Tan Y H
Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
Department of Respiratory and Critical Care Medicine, Sengkang General Hospital, Singapore.
Int J Tuberc Lung Dis. 2022 Jun 1;26(6):537-543. doi: 10.5588/ijtld.21.0723.
TB continues to impose a significant healthcare burden despite advancement in diagnostics and increased availability of effective antimicrobials. Recent years have seen a resurgence of the disease in association with increasing life expectancy and use of immunosuppressive therapy. Mortality remains high in TB patients requiring admission to critical care units. We conducted a retrospective study in two public hospitals to determine factors associated with mortality in patients with TB requiring critical care admission. All patients aged ≥21 years with a diagnosis of active TB involving any organ system at the time of a critical care admission were eligible. The primary outcome measure was 30-day mortality. Over the study period of 4 years, 148 patients were identified. Overall 30-day mortality was 36.5%. Based on multivariate analysis, factors which independently correlated with 30-day mortality include higher APACHE II (Acute Physiology and Chronic Health Evaluation II) score, acid-fast bacilli smear positivity, initiation of anti-TB treatment prior to critical care admission and need for renal replacement therapy. TB in critically ill patients continues to be associated with significant mortality. The factors identified to be associated with poor survival outcomes in our study were largely related to greater disease burden and potential for suboptimal treatment.
尽管诊断技术有所进步，有效的抗菌药物供应也有所增加，但结核病仍然给医疗保健带来了沉重负担。近年来，随着预期寿命的延长和免疫抑制疗法的使用，该疾病有所复发。需要入住重症监护病房的结核病患者死亡率仍然很高。我们在两家公立医院进行了一项回顾性研究，以确定需要重症监护的结核病患者死亡率的相关因素。所有年龄≥21岁、在重症监护入院时被诊断为累及任何器官系统的活动性结核病患者均符合条件。主要结局指标是30天死亡率。在4年的研究期间，共确定了148例患者。总体30天死亡率为36.5%。基于多变量分析，与30天死亡率独立相关的因素包括较高的急性生理与慢性健康状况评分系统II（APACHE II）评分、抗酸杆菌涂片阳性、在重症监护入院前开始抗结核治疗以及需要肾脏替代治疗。重症患者的结核病仍然与显著的死亡率相关。在我们的研究中确定的与生存结局不佳相关的因素主要与更大的疾病负担和治疗效果欠佳的可能性有关。
