Abstract
BackgroundTo investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment.MethodsThis analysis included critically ill patients with tuberculosis. The utility of APACHE-II score for predicting drug withdrawal was evaluated using receiver operating characteristic (ROC) curve analysis.ResultsAmong 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn. The drug withdrawal group had higher APACHE-II score (median [interquartile range]: 21 [3–52] vs. 17 [4–42] points), higher CD4%, lower hemoglobin level, higher rates of chronic obstructive pulmonary disease (COPD) and chronic renal failure, and lower rate of extrapulmonary tuberculosis (P < 0.05). Logistic regression identified APACHE-II score > 18 (odds ratio [95% confidence interval]: 2.099 [1.321–3.334], P < 0.01), COPD (1.913 [1.028–3.561], P < 0.05) and hemoglobin level (0.987 [0.977–0.997], P < 0.05) as independent factors associated with drug withdrawal. At an optimal cutoff of 18.5, the sensitivity, specificity, positive predictive value and negative predictive value of APACHE-II score for predicting drug withdrawal was 59.2, 61.8, 56.9 and 64.1%, respectively.ConclusionsAPACHE-II score > 18 points might predict patient tolerance of anti-tuberculosis treatment.
Highlights
To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment
Data collection Data including age, gender, clinical characteristics of the tuberculosis episode, comorbidities and other relevant clinical factors, blood tests, Sequential Organ Failure Assessment (SOFA) score [23], APACHE-II score [21], anti-tuberculosis treatment regimen used, drug therapy, drug withdrawal, and adverse reactions were recorded
The results showed that APACHE-II score > 18 (OR: 2.10; 95% CI: 1.32–3.33; P < 0.01), comorbid chronic obstructive pulmonary disease (COPD) (OR: 1.91; 95% CI: 1.03–3.56; P < 0.05) and hemoglobin level (OR: 0.99; 95% CI: 0.98–0.997; P < 0.05)
Summary
To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment. Tuberculosis is a global public health problem and the leading cause of death due to infection [1]. In 2016, there were 10.4 million incident cases of tuberculosis and 1.7 million deaths due to the disease [1]. China has the third-highest incidence of tuberculosis after India and Indonesia [1]. Elderly patients with tuberculosis often have comorbidities, organ dysfunction or organ failure, which complicates the successful management of the infection. Elderly patients with tuberculosis tend to have more extensive pulmonary lesions, higher sputum positivity, a higher susceptibility to the adverse effects of anti-tuberculosis drugs (including hepatic dysfunction) and higher mortality [5,6,7,8]. The treatment of elderly patients who are critically ill with tuberculosis is highly challenging
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