Tuberculosis in the intensive care unit: a prospective observational study

SETTING: Data on the determinants of tuberculosis (TB) mortality in the intensive care unit (ICU) are scarce. OBJECTIVE: To describe factors influencing outcomes of patients admitted with TB requiring mechanical ventilation. DESIGN: All TB patients admitted to the ICU of an academic hospital in South Africa from January 2012 to May 2013 were enrolled. Disease severity was graded according to the Acute Physiology And Chronic Health Evaluation (APACHE II) score. Comorbid diagnoses, clinical features, radiological and laboratory investigations and outcomes were recorded. RESULTS: Of 83 patients (mean age 36.5 +/- 12.9 years; 45 females; 44 human immunodeficiency virus [HIV] positive) admitted with pulmonary (n = 69) and/or extra-pulmonary (n = 37) TB, 39 died in the ICU (mortality 44.2%), and a further 10 died during hospitalisation (in-hospital mortality 59.0%). Few clinical parameters, special investigations or other ancillary tests predicted outcome. Only CD4 count <200 cells/mm(3) in HIV-co-infected patients (P = 0.043) and absence of lobar consolidation (P = 0.018) were associated with ICU mortality, whereas a high APACHE II score (22.6 vs. 18.1, P = 0.016) and development of renal failure (P = 0.016) were associated with hospital mortality. CONCLUSION: The mortality of TB patients admitted to the ICU was extremely high. Very few parameters were associated with poor outcome, and no single parameter predicted both ICU and in-patient mortality.