• Valliappan Muthu, Ritesh Agarwal, Sahajal Dhooria, Ashutosh N Aggarwal, Digambar Behera, and Inderpaul Singh Sehgal.
• Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
• Respir Care. 2018 Dec 1; 63 (12): 1541-1554.

BackgroundThe outcomes of patients with tuberculosis admitted to an ICU remain undetermined. Herein, we reviewed the literature to describe the mortality of subjects with tuberculosis who are critically ill, and explore the effect of glucocorticoids on survival.MethodsA systematic review of medical literature databases was performed for studies that describe the outcome of subjects with tuberculosis who required ICU admission. We calculated the proportion of hospitalized subjects with tuberculosis who required ICU admission. Pooled estimates of ICU and hospital mortality, and tuberculosis-related ARDS were calculated. We also studied the effect of systemic glucocorticoids on survival of subjects with tuberculosis who were critically ill.ResultsA total of 35 studies (N = 1,815) were included. The pooled proportion of hospitalized subjects with tuberculosis who required ICU admission was 3.4% (95% CI 1.6-5.7%). The pooled ICU and hospital mortality was 48% (95% CI 41-55%) and 54% (95% CI 46-62%), respectively. Tuberculosis-related ARDS was associated with higher odds (odds ratio 3.88, 95% CI 1.73-8.72) of death. The use of glucocorticoids was not related to an improvement in survival (odds ratio 0.65, 95% CI 0.27-1.57).ConclusionsTuberculosis is a rare cause of ICU admission but is associated with high mortality. Tuberculosis-related ARDS is also associated with lower survival. The role of glucocorticoids in patients with tuberculosis who are critically ill remains unclear and needs further evaluation.Copyright © 2018 by Daedalus Enterprises.

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