Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure

Objectives: To clarify the patterns of pulmonary tuberculosis (TB) that sho uld result in a high index of suspicion, to increase the chances of early t herapy and to identify predictors of 30-day mortality. Patients and methods: Retrospective, 7-year study in two medical intensive care units (ICUs). All patients admitted with pulmonary TB were enrolled. C linical and laboratory data at admission and events within 48 h of admissio n were collected. Predictors of 30-day mortality were identified by univari ate and multivariate analysis. Results: The study included 99 patients with a median age of 41 years. Immu nodeficiency was present in 60 patients, including 38 with AIDS. Fifty-nine patients had pulmonary TB alone, 22 also had extrapulmonary TB and 18 had miliary. All 99 patients were admitted for acute respiratory failure, some also with shock (20), neurologic disorders (18) or acute renal failure (10) . Mechanical ventilation was needed in 50 patients; 22 patients met criteri a for acute respiratory distress syndrome (ARDS). The 30-day mortality rate was 26.2 %. Four factors independently predicted mortality: a time from sy mptom onset to treatment of more than 1 month (OR, 3.49; CI, 1.20-10.20), t he number of organ failures (OR, 3.15; CI, 1.76-5.76), a serum albumin leve l above 20 g/l (OR, 3.96; CI, 1.04-15.10), and a larger number of lobes inv olved on chest radiograph (OR, 1.83; CI, 1.12-2.98). Conclusion: Delayed clinical suspicion and treatment of active pulmonary TB with respiratory failure may contribute to the persistently high mortality rates in ICU patients with these diseases.