, Mustafa Alkan 1
, Kaniye Aydın 2
, Hilal Sipahioğlu 3
, Sahin Temel 1
, Nur Aleyna Yetkin 4
, Nilgün Alptekinoğlu Mendil 5
, Ömer Doğan 2
, Berkan Akçakaya 6
, Sevda Onuk 3
, Hüseyin Arıkan 7
, Umut Sabri Kasapoğlu 7
, Kamuran Uluç 8
, Dinçer Göksuluk 9
, Murat Sungur 1
2Division of Medical Intensive Care Unit, Department of Internal Medicine, Çukurova University Faculty of Medicine, Adana, Türkiye
3Department of Intensive Care, Health Science University, Kayseri Faculty of Medicine, Kayseri, Türkiye
4Department of Chest Diseases, Erciyes University Faculty of Medicine, Kayseri, Türkiye
5Department of Intensive Care, Mersin City Hospital, Mersin, Türkiye
6Department of Internal Medicine, Health Science University, Kayseri Faculty of Medicine, Kayseri, Türkiye
7Department of Pulmonary and Critical Care Medicine, Marmara University Faculty of Medicine, İstanbul, Türkiye
8Department of Intensive Care, Muş State Hospital, Muş, Türkiye
9Department of Biostatistics, Erciyes University Faculty of Medicine, Kayseri, Türkiye
Abstract
Objective: Tuberculosis (TB) has emerged as a significant cause of morbidity and mortality within intensive care units (ICUs). This study evaluates the clinical characteristics and treatment processes of TB patients in ICUs to inform management strategies.
Materials and Methods: This multicenter retrospective study assessed newly diagnosed TB cases admitted to ICUs between January 2019 and January 2024. The primary outcome was mortality rates, while secondary outcomes included clinical characteristics affecting mortality. Medical records from six hospitals were reviewed for active TB patients with confirmed diagnoses.
Results: Among 67 ICU patients studied, 34 (51%) died. Significant associations with increased mortality were found for lower Glasgow Coma Scale scores (GCS) (p=0.003), higher Sequential Organ Failure Assessment (SOFA) scores (p=0.020), and elevated Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (p=0.004). Mortality rates were notably higher in patients with multiple comorbidities and nutritional deficiencies. Cox regression analysis identified the Charlson Comorbidity Index (hazard ratio [HR]=1.35, p=0.031) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR=1.39, p=0.0483) as significant mortality predictors. Kaplan-Meier analysis indicated that patients with high mNUTRIC scores had significantly lower survival probabilities (p=0.004).
Conclusion: Approximately half of the ICU patients with TB died during hospitalization. This study highlights nutritional deficiencies as a key mortality predictor, aiding in the development of improved treatment strategies for TB patients in critical care settings.