[Sportschosun, Jang Jong-ho] A study has found that early blood tests at admission can predict the risk of transfer to the intensive care unit for patients with pulmonary tuberculosis.
Tuberculosis is a major infectious disease in South Korea, with about 15,000 new cases reported each year. Most patients complete treatment in outpatient clinics or general wards, but some deteriorate rapidly and may require intensive care. Patients with severe pulmonary TB who need ICU treatment face a very high risk of death, and domestic and international studies have reported mortality rates as high as 50% to 70%.
A research team led by Professor Kim Jeong-hyeon of the Department of Pulmonology and Allergy at Hallym University Dongtan Sacred Heart Hospital reported the findings in a study titled "Factors predicting the need for intensive care in patients admitted for pulmonary TB."
The team analyzed 623 hospitalized patients with pulmonary TB who were not infected with HIV between July 2013 and March 2017. They compared 32 patients who were transferred from general wards to the ICU with 55 general-ward patients matched for age, sex, and the extent of lung involvement on CT scans.
The analysis showed that the two groups had similar imaging severity on CT scans, but there were clear differences in early blood test results after admission.
Patients whose albumin level at admission was below 2.0 g/dL had about a 17.8 times higher risk of being transferred from a general ward to the ICU than those with levels above 3.0 g/dL. Even among patients with albumin levels between 2.0 and 3.0 g/dL, the risk of ICU transfer rose to about seven times higher. In other words, the lower the albumin level, the greater the risk of ICU care during hospitalization. Albumin is a plasma protein produced in the liver, and blood albumin levels reflect not only a patient's nutritional status but also overall health, including systemic inflammation and disease severity.
The outcomes for patients transferred to the ICU were also very poor. Their average ICU stay was 22.5 days, and their total hospital stay was 42.9 days, more than twice as long as the 18.5 days seen in the general-ward group. Most notably, all 55 patients treated only in the general ward survived, while 25 of the 32 patients transferred to the ICU, or 78.1%, died during hospitalization.
In sputum culture tests, the rate of negative conversion, meaning the tuberculosis bacteria no longer grew after two months of anti-tuberculosis drug treatment, was 70.9% in the general-ward group but only 15.6% in the ICU group, showing poor treatment outcomes among ICU patients.
Professor Kim Jeong-hyeon said, "Patients with pulmonary TB can deteriorate rapidly even after being admitted to a general ward and may require intensive care, but indicators that can predict this early have not been sufficiently identified until now." He added, "Through this study, we confirmed that the lower the albumin level at admission, the significantly higher the risk of ICU transfer."
He also noted, "Albumin levels reflect both a patient's nutritional status and systemic inflammation caused by infection. If we closely monitor albumin levels from the early stage of hospitalization and manage patients with low albumin as a high-risk group, we may be able to respond proactively to clinical deterioration."
The findings were recently published in the SCIE-indexed international journal International Journal of Tuberculosis and Lung Disease.
Jang Jong-ho, bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
