SESSION TITLE: Tuberculosis Posters
SESSION TYPE: Poster Presentations
PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM
PURPOSE: To identify patient characteristics and risk factors associated with in-hospital mortality of PTB patients requiring ICU management.
METHODS: A retrospective chart review of all patients with active PTB at Singapore General Hospital, a tertiary care university-affiliated hospital, between January 2005 to December 2010 inclusive was conducted. Active PTB was defined as smear positive for acid-fast bacilli, and/or culture positive for mycobacterium tuberculosis complex. Immunocompromised patients were defined as those with HIV, active malignancy, and long-term steroids. Patients admitted for reasons not due to PTB were excluded. All data analysed were taken within the first 24 hours of ICU admission. Statistical analysis was performed using SPSS Statistics 17.0. For univariate analysis Chi Square test was used for categorical variables and Student T test for continuous variables. For multivariate analysis, logistic regression was performed.
RESULTS: Over this 6 year period, there were 2155 patients with newly diagnosed active PTB infection at Singapore General Hospital, of whom 83 patients were admitted to ICU. 8 of these patients were excluded from further analysis because their admission was unrelated to PTB (acute abdomen n=3, bleeding gastrointestinal tract n=1, spine surgery n=1, atrial flutter with hypotension n=1, post-operation complications n=2). The remaining 75/2155(3.5%) patients were eligible for analysis. The most common comorbidities were diabetes mellitus (30.7%) and immunocompromised host (33%). 4/75(5.3%) patients had HIV co-infection. 67/75(89.3%) patients required mechanical ventilation, and the mean duration of mechanical ventilation was 8.05±14.43 days. Mean duration of ICU stay and hospital stay were 10.23±15.8 days and 33.7±50.7 days respectively. In-hospital mortality was 47/75(62.7%), of whom 36 died whilst in ICU (ICU mortality 48%). Univariate analysis identified ischaemic heart disease, albumin, PaO2/FiO2 ratio, APACHE II, disseminated intravascular coagulation, shock and multiorgan failure were significantly associated with mortality(Table1). Multivariate analysis showed that low albumin on day of ICU admission was the only significant independent predictor of death (p=0.015).
CONCLUSIONS: Our in-hospital mortality from severe PTB requiring ICU admission was 62.7%, and albumin was an independent predictor for mortality.
CLINICAL IMPLICATIONS: Albumin is an independent predictor for mortality of PTB patients requiring ICU.
DISCLOSURE: The following authors have nothing to disclose: Wann Jia Loh, Yue Yu, Chian Min Loo, Su Ying Low
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