Objective: The purpose of this study was to investigate the prognostic factors associated with mortality in critically ill tuberculosis patients, and therefore to provide information for the early diagnosis and treatment of the disease.
Methods: The clinical data of 62 patients with tuberculosis, who were admitted to the intensive care unit (ICU) of Integrated Chinese and Western Medicine Hospital of Zhejiang Province between June 2008 and Feb 2010, were analyzed retrospectively, with the admission date as a start point and the transferring out of ICU date or death date in the ICU as an end point. Forty-eight patients were males and 14 were females, and the patient's age ranging from 20 to years (63 ± 4) years. In addition, these patients were divided into the survival (33 cases) and the death groups (29 cases). A total of 19 factors including age, sex, respiratory failure types, mechanical ventilation, infection, anti-tuberculous drug resistance, chemotherapy, clinical complications, critical illness score, liver damage, were analyzed for a single risk factor by the univariate model, and calculated for the independent death risk factors using the Cox logistic regression multivariate model. The cumulative survival rate based on the Kaplan-Meier survival model was calculated.
Results: The mortality was associated with 4 independent factors: fungal infection (HR = 3.44, 95%CI = 1.23 - 9.62), type II respiratory failure (HR = 4.03, 95%CI = 1.56 - 10.38), liver damage (HR = 3.96, 95%CI = 1.30 - 12.10) and elevated APACHEII score (> 25) (HR = 4.91, 95%CI = 1.99 - 12.11). These factors significantly (χ(2) = 5.53 - 11.88, all P < 0.05) increased the in-hospital mortality and decreased the hospital cumulative survival rate (χ(2) = 4.43 - 22.68, all P < 0.05).
Conclusion: The high mortality of tuberculosis patients admitted to ICU was associated with fungal infection, type II respiratory failure, liver damage, and elevated APACHE II score (> 25).