Risk factors and predictive model for poor prognosis among HIV-negative patients with disseminated tuberculosis admitted to intensive care unit

doi:10.19982/j.issn.1000-6621.20250491

Abstract

Abstract:

Objective: This study aimed to explore the risk factors for poor prognosis among human immunodeficiency virus (HIV)-negative patients with disseminated tuberculosis (DTB) admitted to intensive care unit (ICU). Methods: The clinical data of 204 HIV-negative patients with DTB admitted to the Tuberculosis ICU of Changsha Central Hospital between January 1, 2021 and December 31, 2023 was retrospectively analyzed. Patients were divided into a poor prognosis group (n=49) and a favorable prognosis group (n=155) according to their treatment outcomes at ICU discharge. The clinical characteristics of the two groups were compared, and multivariate logistic regression analysis was used to identify risk factors for poor prognosis in patients with DTB and a risk prediction model for poor prognosis was constructed. Results: Among the 204 HIV-negative patients with DTB, the incidence of poor prognosis in the ICU was 24.0% (49/204). Multivariate logistic regression analysis revealed that positive acid-fast bacilli in sputum smear (OR=2.878, 95%CI: 1.128-7.348, P=0.027), inadequate initial antituberculosis therapy at ICU admission (OR=2.779, 95%CI: 1.212-6.369, P=0.016), and concurrent severe pneumonia (OR=14.746, 95%CI: 4.204-51.727, P<0.001), and concurrent sepsis (OR=4.023, 95%CI: 1.788-9.051, P<0.001) were possible risk factors for poor prognosis among HIV-negative patients with DTB admitted to ICU. A risk prediction model for poor prognosis was constructed based on the above risk factors. The area under the receiver operating characteristic (AUC) curve of the model was 0.869 (95%CI: 0.815-0.923, P<0.001), with a sensitivity of 85.7% and a specificity of 72.3%, indicating that the model has good predictive value. Conclusion: For HIV-negative patients with DTB admitted to ICU, positive acid-fast bacilli in sputum smear, inadequate initial antituberculosis therapy on ICU admission, and concurrent severe pneumonia and sepsis are associated with an increased risk of poor prognosis. Clinically, early identification of these risk factors and targeted interventions are required to improve patients’ clinical outcomes.

Key words: Tuberculosis, Intensive care, Prognosis, Risk factors, Prediction model, Factor analysis, statistical

CLC Number:

R521

Liu Jia, Tan Jing, Tian Yao, Fu Manjiao, Liu Huimin, Chen Hongmei, Zhai An, Kang Yi, Chen Liang, Bei Chengli. Risk factors and predictive model for poor prognosis among HIV-negative patients with disseminated tuberculosis admitted to intensive care unit[J]. Chinese Journal of Antituberculosis, 2026, 48(7): 933-940. doi: 10.19982/j.issn.1000-6621.20250491

Figures/Tables 6

References 30

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因素	总计 (204例)	预后不良组 (49例)	预后良好组 (155例)	统计检验值	P值
一般情况
年龄[岁, $\bar{x}±s$]	56.2±19.1	59.8±18.6	55.1±19.2	t=1.509	0.133
男性[例(构成比,%)]	150(73.5)	36(73.5)	114(73.5)	χ²=0.000	0.991
吸烟[例(构成比,%)]	85(41.7)	21(42.9)	64(41.3)	χ²=0.038	0.846
饮酒[例(构成比,%)]	54(26.5)	15(30.6)	39(25.2)	χ²=0.568	0.451
症状持续时间[月,M(Q₁,Q₃)]	1.0(0.7,4.0)	2.0(0.8,5.5)	1.0(0.5,3.0)	Z=-2.143	0.032
APACHE Ⅱ评分[分, $\bar{x}±s$]	20.4±8.3	25.1±8.4	18.9±7.7	t=4.812	<0.001
NRS 2002评分[分, $\bar{x}±s$]	4.9±1.3	5.1±1.5	4.8±1.3	t=1.664	0.098
既往基础疾病
慢性肺病[例(构成比,%)]	49(24.0)	12(24.5)	37(23.9)	χ²=0.008	0.930
糖尿病[例(构成比,%)]	48(23.5)	12(24.5)	36(23.2)	χ²=0.033	0.856
慢性肾脏病[例(构成比,%)]	43(21.1)	15(30.6)	28(18.1)	χ²=3.524	0.060
慢性肝病[例(构成比,%)]	34(16.7)	9(18.4)	25(16.1)	χ²=0.134	0.714
自身免疫性疾病[例(构成比,%)]	32(15.7)	9(18.4)	23(14.8)	χ²=0.351	0.554
血液系统疾病[例(构成比,%)]	24(11.8)	9(18.4)	15(9.7)	χ²=2.708	0.100
实体肿瘤[例(构成比,%)]	8(3.9)	1(2.0)	7(4.5)	χ²=0.605	0.437
基线实验室资料
降钙素原[ng/ml,M(Q₁,Q₃)]	0.9(0.2,4.8)	3.0(0.7,11.9)	0.6(0.1,3.7)	Z=-3.588	<0.001
C反应蛋白[mg/l,M(Q₁,Q₃)]	59.4(27.4,100.6)	80.4(48.5,118.0)	50.0(23.9,96.5)	Z=-2.815	0.005
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	7.9(5.5,11.5)	10.0(5.7,16.3)	7.4(5.3,10.3)	Z=-2.475	0.013
血红蛋白[g/L,M(Q₁,Q₃)]	91.0(73.0,109.0)	93.0(73.5,111.0)	90.0(73.0,108.0)	Z=-0.584	0.559
白蛋白[g/L,M(Q₁,Q₃)]	27.0(24.0,31.0)	25.0(23.0,28.0)	28.0(24.0,32.0)	Z=-2.734	0.006

因素	总计 (204例)	预后不良组 (49例)	预后良好组 (155例)	χ²值	P值
浸润性肺结核	98(48.0)	19(38.8)	79(51.0)	2.217	0.136
血行播散性肺结核	80(39.2)	16(32.7)	64(41.3)	1.165	0.280
空洞性肺结核	60(29.4)	19(38.8)	41(26.5)	2.724	0.099
痰涂片抗酸杆菌阳性	44(21.6)	17(34.7)	27(17.4)	6.567	0.010
痰分枝杆菌培养阳性	62(30.4)	16(32.7)	46(29.7)	0.156	0.693
≥2个部位肺外结核	81(39.7)	18(36.7)	63(40.6)	0.238	0.626
肠结核	106(52.0)	27(55.1)	79(51.0)	0.255	0.614
中枢神经系统结核	78(38.2)	17(34.7)	61(39.4)	0.342	0.558
复治结核病	52(25.5)	11(22.4)	41(26.5)	0.314	0.575
耐药结核病	15(7.4)	5(10.2)	10(6.5)	0.770	0.380
并发肝功能不全	90(44.1)	25(51.0)	65(41.9)	1.246	0.264
并发肾功能不全	70(34.3)	24(49.0)	46(29.7)	6.154	0.013
并发呼吸衰竭	118(57.8)	33(67.3)	85(54.8)	2.389	0.122
并发重症肺炎	108(52.9)	46(93.9)	62(40.0)	43.379	<0.001
并发脓毒症	67(32.8)	33(67.3)	34(21.9)	34.809	<0.001

因素	总计 (204例)	预后不良组 (49例)	预后良好组 (155例)	χ²值	P值
入住ICU初始抗结核治疗药物不足	44.1(90/204)	61.2(30/49)	38.7(60/155)	7.655	0.006
抗结核药物不良反应	69.7(138/198)	80.4(37/46)	66.4(101/152)	3.271	0.071

变量	赋值	变量	赋值
症状持续时间(月)	原值纳入	痰涂片抗酸杆菌结果	阴性=0,阳性=1
APACHEⅡ评分(分)	<20=0,≥20=1	入住ICU初始抗结核治疗药物不足	无=0,有=1
降钙素原(ng/ml)	<2=0,≥2=1	并发肾功能不全	无=0,有=1
C反应蛋白(mg/L)	原值纳入	并发重症肺炎	无=0,有=1
白细胞计数(×10⁹/L)	原值纳入	并发脓毒症	无=0,有=1
白蛋白(g/L)	>30=0,≤30=1

因素	β值	s${}_{\overline{x}}$值	Wald χ²值	P值	OR(95%CI)值
痰涂片抗酸杆菌阳性	1.057	0.478	4.889	0.027	2.878(1.128~7.348)
入住ICU初始抗结核治疗药物不足	1.022	0.423	5.831	0.016	2.779(1.212~6.369)
并发重症肺炎	2.691	0.640	17.663	<0.001	14.746(4.204~51.727)
并发脓毒症	1.392	0.414	11.324	<0.001	4.023(1.788~9.051)