Risk factors for death in tuberculosis patients requiring ICU care

Diagnostic value of the combined test of leukocytes in urine and TB-DOT and T-SPOT.TB in blood for urinary tuberculosis

Background

This study aims to evaluate the clinical utility of routine urinary tests and renal function assessments, as well as the Tuberculosis antibody test (TB-DOT) and T-cell spot tests for TB infection (T-SPOT.TB), either individually or in combination, for diagnosing urinary tuberculosis (UTB).

Methods

We conducted a retrospective analysis of urinary routine tests, renal function tests, TB-DOT, and T-SPOT.TB-administered alone or in combination-in 95 patients suspected of having UTB from January 2020 to December 2022 at our institution.

Results

Significant differences were observed in the levels or positivity of white blood cells (WBC), red blood cells (RBC), creatinine (Crea), TB-DOT, and T-SPOT.TB between the UTB group and the non-UTB group (P < 0.05). Among the individual tests, T-SPOT.TB exhibited the highest specificity and positive predictive value (PPV), while WBC demonstrated the highest area under the curve (AUC). Both TB-DOT and RBC showed relatively good sensitivity. Additionally, WBC levels correlated with both TB-DOT and T-SPOT.TB results. The combination of WBC, TB-DOT, and T-SPOT.TB provided the best sensitivity, negative predictive value (NPV), and AUC when evaluated in parallel with the other tests.

Conclusion

For the early identification of UTB, the sensitivity of T-SPOT.TB and TB-DOT tests is superior to that of routine urinary and renal function tests. The parallel combination of WBC, TB-DOT, and T-SPOT.TB offers enhanced diagnostic efficacy for UTB, facilitating rapid clinical diagnosis.

Epidemiology and outcomes of patients with tuberculosis requiring extracorporeal membrane oxygenation: An ELSO registry analysis

PURPOSE

This study aimed to analyze data from the Extracorporeal Life Support Organization (ELSO) registry to elucidate the epidemiology and outcomes of patients with tuberculosis necessitating extracorporeal membrane oxygenation (ECMO), an intervention typically employed in treating severe acute respiratory distress syndrome (ARDS), but infrequently reported in tuberculosis contexts.

METHODS

A retrospective analysis was conducted utilizing the ELSO registry data spanning from 2003 to 2022, specifically targeting patients with tuberculosis who underwent ECMO. Primary outcomes included survival to hospital discharge, while secondary outcomes encompassed pre-ECMO support, ECMO duration, complications, and discharge destinations. Univariate and multivariate Cox proportional hazard regression analyses were employed to identify factors influencing survival rates.

RESULTS

The analysis included 169 patients with tuberculosis, with a median ECMO support duration of 233 h. The weaning success rate was recorded at 62.7 %, and 55 % of patients achieved survival to hospital discharge. Complications arose in 69.8 % of cases, predominantly mechanical complications (46.6 %). Multivariate Cox regression analysis identified complications (HR: 0.448, 95 % CI: 0.222-0.748, P=0.001), infections (HR: 0.483, 95 % CI: 0.241-0.808, P=0.001), and prolonged intervals from admission to ECMO initiation (HR: 0.698, 95 % CI: 0.396-0.901, P=0.018) as significant factors correlated with decreased survival likelihood.

CONCLUSION

ECMO presents as a viable treatment option for patients with tuberculosis; however, timely initiation and meticulous management are critical to mitigate complications and enhance patient outcomes.

IMPLICATION FOR CLINICAL PRACTICE

Accurate identification of optimal ECMO initiation timing for eligible patients with tuberculosis can significantly enhance clinical outcomes in critical care settings, such as intensive care units.

The association between blood urea nitrogen to albumin ratio and the 28 day mortality in tuberculosis patients complicated by sepsis

The relationship between blood urea nitrogen to albumin ratio (BAR) and the prognosis of patients with tuberculosis (TB) complicated by sepsis remains unclear. This study aimed to explore the association between BAR and overall patient prognosis. This was a retrospective cohort study of patients with TB complicated by sepsis who were admitted to the intensive care unit (ICU) of the Public Health Clinical Center of Chengdu between January 2019 and February 2023. The relationship between BAR values and prognosis in these patients was investigated using multivariate Cox regression, stratified analysis with interaction, restricted cubic spline (RCS), and threshold effect analysis. Sensitivity analyses were conducted to assess the robustness of the results. Our study included 537 TB patients complicated by sepsis admitted in the ICU, with a median age of 63.0 (48.0, 72.0) years; 76.7% of whom were men. The multivariate-restricted cubic spline analysis showed a non-linear association between BAR and patient prognosis. In the threshold analysis, we found that TB patients complicated by sepsis and a BAR < 7.916 mg/g had an adjusted hazard ratio (HR) for prognosis of 1.163 (95% CI 1.038-1.303; P = 0.009). However, when the BAR was ≥ 7.916 mg/g, there was no significant increase in the risk of death. The results of the sensitivity analysis were stable.

Factors Affecting Mortality in Critically Ill Patients With Tuberculosis: A Systematic Review and Meta-Analysis

OBJECTIVES

Critically ill patients with tuberculosis carry high mortality. Identification of factors associated with mortality in critically ill tuberculosis patients may enable focused treatment.

DATA SOURCES

An extensive literature search of PubMed (MEDLINE), Embase, the Cochrane Library, and Google Scholar was performed using Medical Subject Headings terms "tuberculosis," "critical care," "critical care outcome," and "ICU." We aimed to identify factors affecting mortality in critically ill tuberculosis patients.

STUDY SELECTION

All the studies comparing factors affecting mortality between survivors and nonsurvivors in critically ill tuberculosis patients were included. The database search yielded a total of 3017 records, of which 17 studies were included in the meta-analysis.

DATA EXTRACTION

Data were collected including the name of the author, year and country of publication, duration of the study, number of patients studied, type of tuberculosis, patient demography, smoking history, laboratory parameters, comorbidities, the requirement for mechanical ventilation, duration of ventilation, ICU and hospital length of stay (LOS), type of lung involvement, complications, and outcomes.

DATA SYNTHESIS

The major factors that contributed to mortality in critically ill tuberculosis patients were age, platelet count, albumin, C-reactive protein (CRP), the requirement and duration of invasive mechanical ventilation, Pa o2 /F io2 ratio, presence of acute respiratory distress syndrome, shock, hospital-acquired infections, renal replacement therapy, and ICU and hospital LOS.

CONCLUSIONS

Patient age, platelet count, albumin and CRP levels, the requirement and duration of invasive mechanical ventilation, Pa o2 /F io2 ratio, hospital-acquired infections, renal replacement therapy, and ICU LOS were variables associated with mortality.

Influence of age, IGRA results, and inflammatory markers on mortality in hospitalized tuberculosis patients

INTRODUCTION

Tuberculosis (TB) remains a leading cause of death globally. Identifying the factors associated with mortality during hospitalization for TB is crucial for improving patient outcomes. This study aimed to investigate the potential risk factors, including T-SPOT.TB test results and routine laboratory markers of inflammation, associated with death during hospitalization due to TB.

METHODS

A retrospective analysis was conducted on 244 hospitalized TB patients. Demographic data, clinical characteristics, T-SPOT.TB results, and laboratory parameters were collected. Univariate and multivariate analyses were performed to identify independent risk factors for in-hospital mortality.

RESULTS

Among the patients, 206 survived and 38 died during hospitalization. Multivariate analysis revealed that age (HR: 1.08, 95% CI: 1.02-1.15, p = 0.001), a negative T-SPOT.TB test result (HR: 4.01, 95% CI: 1.78-9.01, p < 0.001), elevated C-reactive protein (CRP) levels (HR: 1.04, 95% CI: 1.01-1.08, p = 0.007), and increased neutrophil-to-lymphocyte ratio (NLR) (HR: 1.04, 95% CI: 1.00-1.07, p = 0.025) were independent risk factors for mortality.

CONCLUSIONS

This study identified age, a negative T-SPOT.TB result, elevated CRP levels, and a high NLR as significant independent risk factors for death in hospitalized TB patients. These findings underscore the importance of these parameters in the risk stratification and management of hospitalized TB patients. Further research is warranted to elucidate the mechanisms behind these associations and to validate these results in different populations.

Development and evaluation of an early rehabilitation nursing program for patients with pulmonary tuberculosis

To develop and evaluate an early rehabilitation nursing program for patients with pulmonary tuberculosis to improve their exercise endurance, pulmonary function, and self-care ability, promote their rehabilitation, improve their quality of life, and explore the construction and application of early rehabilitation nursing program. From March 2021 to August 2022, 104 patients with pulmonary tuberculosis in the improvement stage were recruited and randomly assigned to an intervention group (n = 52) and a control group (n = 52). Exercise endurance was assessed before and 12 weeks after the nursing program, and the groups were compared. Changes in pulmonary function were also analyzed. The exercise of self-care agency scale, self-rating depression scale, self-rating anxiety scale, and generic quality of life inventory-74 were used to assess differences in patients' quality of life. Patients in the intervention group performed significantly better than those in the control group in the 6-minute walking test, and had significantly higher arterial blood oxygen partial pressure and significantly lower arterial partial pressure of carbon dioxide after the intervention (P < .001). After the intervention, the forced vital capacity and forced expiratory volume in 1 second in the intervention group were significantly higher than those in the control group (P < .001). After the intervention, the scores for health knowledge (P < .001), self-care skills (P = .001), self-concept (P < .001) and self-care responsibility (P = .002) of patients in the intervention group were significantly higher, and the self-rating depression scale, self-rating anxiety scale, and generic quality of life inventory-7 scores were significantly lower in the intervention group than in the control group (P < .001). This study demonstrates the clinical value of early rehabilitation nursing during the improvement period in patients with pulmonary tuberculosis.

Bacteriophages of Mycobacterium tuberculosis, their diversity, and potential therapeutic uses: a review

Tuberculosis (TB) caused by Mycobacterium tuberculosis (M. tuberculosis) is a highly infectious disease and worldwide health problem. Based on the WHO TB report, 9 million active TB cases are emerging, leading to 2 million deaths each year. The recent emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) strains emphasizes the necessity to improve novel therapeutic plans. Among the various developing antibacterial approaches, phage therapy is thought to be a precise hopeful resolution. Mycobacteriophages are viruses that infect bacteria such as Mycobacterium spp., containing the M. tuberculosis complex. Phages and phage-derived proteins can act as promising antimicrobial agents. Also, phage cocktails can broaden the spectrum of lysis activity against bacteria. Recent researches have also shown the effective combination of antibiotics and phages to defeat the infective bacteria. There are limitations and concerns about phage therapy. For example, human immune response to phage therapy, transferring antibiotic resistance genes, emerging resistance to phages, and safety issues. So, in the present study, we introduced mycobacteriophages, their use as therapeutic agents, and their advantages and limitations as therapeutic applications.

Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis in Hong Kong (2008-2018)

BACKGROUND

Tuberculosis (TB) is a preventable and curable disease, but mortality remains high among those who develop sepsis and critical illness from TB.

METHODS

This was a population-based, multicentre retrospective cohort study of patients admitted to all 15 publicly funded Hong Kong adult intensive care units (ICUs) between 1 April 2008 and 31 March 2019. 940 adult critically ill patients with at least one positive Mycobacterium tuberculosis (MTB) culture were identified out of 133 858 ICU admissions. Generalised linear modelling was used to determine the impact of delay in TB treatment on hospital mortality. Trend of annual Acute Physiology and Chronic Health Evaluation (APACHE) IV-adjusted standardised mortality ratio (SMR) over the 11-year period was analysed by Mann-Kendall's trend test.

RESULTS

ICU and hospital mortality were 24.7% (232/940) and 41.1% (386/940), respectively. Of those who died in the ICU, 22.8% (53/232) never received antituberculosis drugs. SMR for ICU patients with TB remained unchanged over the study period (Kendall's τb=0.37, p=0.876). After adjustment for age, Charlson comorbidity index, APACHE IV, albumin, vasopressors, mechanical ventilation and renal replacement therapy, delayed TB treatment was directly associated with hospital mortality. In 302/940 (32.1%) of patients, TB could only be established from MTB cultures alone as Ziehl-Neelsen staining or PCR was either not performed or negative. Among this group, only 31.1% (94/302) had concurrent MTB PCR performed.

CONCLUSIONS

Survival of ICU patients with TB has not improved over the last decade and mortality remains high. Delay in TB treatment was associated with higher hospital mortality. Use of MTB PCR may improve diagnostic yield and facilitate early treatment.