• Junke Qiu, Caihong Wang, Xiaohong Pan, Lei Pan, Xiaoqing Huang, Jiekun Xu, Xiaobo Ji, and Minjie Mao.
• Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China.
• Bmc Infect Dis. 2019 Feb 4; 19 (1): 106.

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(ROC) curve analysis.ResultsAmong 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn.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.

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