Life-threatening conditions and outcomes of hospitalization in the intensive care unit during treatment of HIV-negative tuberculosis patients

Aim. Was to study the clinical characteristics, causes of decompensation, and outcomes of hospitalizations in the intensive care unit (ICU) of tuberculosis patients without HIV infection.

Materials and methods. A retrospective cohort study was conducted of all ICU admissions of HIV-negative tuberculosis patients aged over 18 years to a specialized tuberculosis hospital between 2022 and 2025. Demographic data, clinical forms of tuberculosis, drug resistance profile of the pathogen, comorbidities, causes of critical conditions, laboratory parameters at ICU admission and transfer from the ICU, methods of intensive care, and treatment outcomes were assessed.

Results. The median age of HIV-negative patients, predominantly male (81.6%), was 44 years [33–62]. In the structure of clinical forms, disseminated (57.1%) and infiltrative (32.6%) tuberculosis were diagnosed; lung tissue destruction was detected in 75.6% of patients, bacterial excretion in 93.8%, pre-extensively drug-resistant (pre-XDR) TB was present in 28.6% of cases, and multidrug-resistant (MDR) TB in 10.1%. Diabetes mellitus was identified in 20.4% of patients. The main reason for ICU admission was acute respiratory failure (65.3%). Mechanical ventilation was required in 18.4% of patients. The median ICU length of stay was 5 days. ICU mortality was 18.4%, and overall, in-hospital mortality was 20.4%. Non-survivors had significantly higher leukocytosis at admission (median 10.6×10⁹/L vs. 8.5×10⁹/L, p=0.04). All deceased patients had destructive forms of tuberculosis with MDR/pre-XDR pathogen.

1. Алюшин С.Н., Скрягина Е.М., Дюсьмикеева М.И. и др. Факторы риска развития критических состояний, требующих госпитализации в отделение интенсивной терапии и реанимации, у пациентов с туберкулезом //Мед. журн. – 2021. – № 2. – С. 44–48.

2. Алюшин С.Н., Скрягина Е.М., Дюсьмикеева М.И. и др. Факторы риска смерти пациентов с туберкулезом в отделении интенсивной терапии и реанимации // Здравоохранение. – 2021. – № 5. – С. 11–15.

3. Комиссарова О.Г., Полушкина Е.Г., Абдуллаев Р.Ю. Туберкулез и сахарный диабет: современное состояние проблемы // Врач. – 2023. – Т. 34. – № 8. – С. 27-32. DOI: 10.29296/25877305-2023-08-05

4. Baker M.A., Harries A.D., Jeon C.Y.et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review // BMC Med. – 2011. – № 9. – P. 81. DOI: 10.1186/1741-7015-9-81

5. Chaudhry D., Tyagi D. Tuberculosis in intensive care unit // Indian J. Crit. Care Med. – 2021. – Vol. 25, Suppl. 2. – P. S150–S154. DOI: 10.5005/jp-journals-10071-23872

6. Galvin J., Tiberi S., Akkerman O. et al. Pulmonary tuberculosis in intensive care setting, with a focus on the use of severity scores, a multinational collaborative systematic review // Pulmonology. – 2022. – Vol. 28, № 4. – P. 297–309. DOI: 10.1016/j.pulmoe.2022.01.016

7. Mishra S., Gala J., Chacko J. et al. Factors affecting mortality in critically ill patients with tuberculosis: a systematic review and meta-analysis // Crit. Care Med. – 2024. – Vol. 52, № 6. – P. e304–e313. DOI: 10.1097/CCM.0000000000006226

8. Valade S., Raskine L., Aout M. et al. Tuberculosis in the intensive care unit: a retrospective descriptive cohort study with determination of a predictive fatality score // Can. J. Infect. Dis. Med. Microbiol. – 2012. – Vol. 23, № 4. – P. 173–178. DOI: 10.1155/2012/361292

9. Wang Z.-L., Yin Q.-Y., Han C. et al. Risk factors for death in tuberculosis patients requiring ICU care // Epidemiol. Infect. – 2021. – Vol. 149. – P. e22. DOI: 10.1017/S0950268820003108

10. World Health Organization. Global tuberculosis report 2024. - Geneva: WHO, 2024. – 68 p.