Características y desenlaces asociados con la mortalidad en la tuberculosis grave en cuidados intensivos: estudio de una cohorte retrospectiva

Abstract

Background

Tuberculosis (TB) remains a major contributor to morbidity and mortality, particularly among critically ill patients. Identifying clinical predictors of mortality in the intensive care unit (ICU) may guide early interventions and improve outcomes. This study aimed to assess the association between multiple clinical variables and 30-day mortality in patients with severe TB admitted to the ICU.

Materials and Methods

This was a single-center retrospective cohort study including adult patients with microbiologically confirmed severe TB admitted to the ICU between 2015 and 2022. Patients with COVID-19, unconfirmed TB diagnosis, or incomplete clinical records were excluded by the investigators. A total of 99 participants were included for analysis. Sociodemographic and clinical variables, ICU complications, and 30-day mortality were assessed using descriptive statistics, bivariate comparisons, and multivariable logistic regression. The study protocol was approved by the institutional ethics committee and conducted in accordance with the Declaration of Helsinki.

Results

Among 1,663 TB patients, 15% required ICU admission. Ninety-nine patients met the inclusion criteria, with a 30-day mortality rate of 47%. Compared to survivors, non-survivors had higher rates of comorbidities (85 vs. 60%; P<.01), septic shock (91 vs. 28%; P<.001), mechanical ventilation, renal replacement therapy, acute respiratory distress syndrome (ARDS), elevated APACHE II scores (median 20 vs. 12; P<.01), higher heart rate, and increased lactate levels. In bivariate analysis, all variables except multilobar pneumonia and PaO₂/FiO₂ ratio were significantly associated with mortality. In the multivariable model, only septic shock (adjusted OR: 18.92; 95% CI: 4.9-72.9), comorbidities (adjusted OR: 4.73; 95% CI: 1.26-17.7), and APACHE II score (adjusted OR: 1.14; 95% CI: 1.03-1.24) remained independent predictors of death.

Conclusion

Severe TB in critically ill patients is associated with high 30-day mortality. Septic shock, the presence of comorbidities, and elevated APACHE II scores were identified as independent risk factors. Early recognition and individualized management of these factors may improve clinical outcomes in this high-risk population.