Analysis of the clinical characteristics and prognosis of patients with hematogenous disseminated tuberculosis admitted to intensive care unit

Liu Jia; Fu Manjiao; Bei Chengli; Chen Hongmei

doi:10.3760/j.issn.1673-4777.2025.04.009

Abstract：Objective To investigate the clinical characteristics and prognosis of patients with hematogenous disseminated tuberculosis(HDTB)admitted to intensive care unit(ICU),and to improve clinicians'understanding of the disease.Methods A total of 130 patients with severe tuberculosis admitted to the tuberculosis ICU of Changsha Central Hospital,Hunan Province from June 2019 to June 2023 were retrospectively analyzed.According to the presence or absence of hematogenous spread and lesion involvement,the patients were divided into HDTB group(42 cases)and local tuberculosis group(88 cases).The clinical characteristics and prognosis of the two groups were compared.Results The proportions of underlying diseases and autoimmune diseases in the HDTB group were higher than those in the local tuberculosis group,while the proportions of cough and expectoration were signif-icantly lower than those in the local tuberculosis group(all P＜0.05).The white blood cell count,hemoglobin and albumin levels of the HDTB group were lower than those of the local tuberculosis group,and the procalcitonin and C-reactive protein levels and the proportions of liver and renal insufficiency were higher than those of the local tuberculosis group(all P＜0.05).The proportion of hematogenous disseminated tuberculosis in the HDTB group was significantly higher than that in the local tuberculosis group,while the proportion of invasive tuberculosis was lower than that in the local tuberculosis group[54.8％(23/42)vs 9.5％(8/84),21.4％(9/42)vs 54.8％(46/84)](both P＜0.05).There was no significant difference in the proportion of cavitary tuberculosis between the two groups(P＞0.05).The positive rate of acid-fast bacilli in HDTB group was significantly lower than that in local tuberculosis group(P＜0.05).The incidences of multiple organ dysfunction syndrome,sepsis and adverse reactions to anti tuberculosis drugs in the HDTB group were significantly higher than those in the local tuberculosis group,and the length of ICU stay and total hospital stay were longer than those in the local tuberculosis group(all P＜0.05).Totally 27 patients(64.3％)in HDTB group were successfully transferred out of ICU after treatment,and 15 patients(35.7％)died in hospital.In the local tuberculosis group,74 patients(84.1％)were discharged from ICU and 14 patients(15.9％)died in hospital.The mortality rate in the HDTB group was significantly higher than that in the local tuberculosis group(P＜0.05).Conclusion HDTB mostly occurs in patients with immunocompromised underlying diseases.The clinical manifestations of HDTB are mainly systemic symptoms,such as lack of specificity,pulmonary imaging is mainly hematogenous disseminated tuberculosis,the positive rate of acid-fast bacilli in sputum is low,the co-infection is more serious,the incidence of multiple organ dysfunction syndrome and sepsis is high,the adverse drug reactions in the process of anti-tuberculosis is easy to occur,the length of hospital stay is long,and the mortality is high.