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Critical care
Original research
Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis (2008–2018)
  1. Christina So1,
  2. Lowell Ling1,
  3. Wai Tat Wong1,
  4. Jack Zhenhe Zhang1,
  5. Chun Ming Ho2,3,
  6. Pauline Yeung Ng4,5,
  7. Hoi Ping Shum6,
  8. Alwin Wai Tak Yeung7,
  9. Kai Cheuk Sin8,
  10. Jacky Chan9,
  11. Ka Fai Au10,
  12. Ting Liong11,
  13. Eunise Ho12,13,
  14. Fu Loi Chow14,
  15. Laptin Ho15,
  16. Kai Man Chan16,
  17. Gavin Matthew Joynt1
  1. 1 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
  2. 2 Department of Intensive Care, Tuen Mun Hospital, Hong Kong, China
  3. 3 Department of Intensive Care, Pok Oi Hospital, New Territories, Hong Kong SAR, China
  4. 4 Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  5. 5 Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
  6. 6 Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
  7. 7 Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, Hong Kong SAR, China
  8. 8 Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong, China
  9. 9 Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
  10. 10 Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China
  11. 11 Department of Intensive Care, United Christian Hospital, Hong Kong, China
  12. 12 Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China
  13. 13 Department of Intensive Care, Yan Chai Hospital, Hong Kong, Hong Kong, China
  14. 14 Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong, China
  15. 15 Department of Intensive Care, North District Hospital, Hong Kong, China
  16. 16 Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
  1. Correspondence to Dr Lowell Ling, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China; lowell.ling{at}cuhk.edu.hk

Abstract

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.

  • Tuberculosis
  • Critical Care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/thorax-2022-218868

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @lingling7

    • Correction notice This article has been corrected since it was published Online First. The title has been modified slightly.

    • Contributors CS, LL and WTW designed the study. LL, JZZ, CS and CMH collected the data. CS and LL performed the data analysis and wrote the first draft of the manuscript together. LL is responsible for the overall content as the guarantor. All other authors critically evaluated the manuscript and approved the final version. No funding or competing interests to declare for this study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.