Abstract:

Objective: To explore the application value of serum C-reactive protein (CRP) and D-dimer in predicting the prognosis of pulmonary tuberculosis patients in the intensive care unit (ICU). Methods: Using a retrospective study methodology, relevant medical history records and 24-hour ICU admission test results of 102 pulmonary tuberculosis patients admitted to the ICU of Hebei Provincial Chest Hospital from April 2022 to April 2024 were collected from the case information system according to the inclusion criteria. According to the survival status of the enrolled patients within 28 days after admission to ICU, they were divided into the survival group (survived within 28 days) and the death group (died within 28 days). A binary logistic regression model analysis was used to analyze the related factors influencing the 28-day prognosis of ICU patients with pulmonary tuberculosis, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of serum CRP and D-dimer levels for the prognosis of pulmonary tuberculosis patients in the ICU. Results: Among the patients with pulmonary tuberculosis admitted to the ICU, 60 cases (58.8%) survived within 28 days, while 42 cases (41.2%) died. Multivariate logistic regression analysis showed that the levels of serum CRP and D-dimer, as well as an increased acute physiology and chronic health evaluation Ⅱ (APAHCE Ⅱ) score, were independent predictors for death within 28 days in ICU patients with pulmonary tuberculosis, with OR values of 1.017 (95%CI:1.003-1.030), 1.318 (95%CI:1.041-1.669) and 1.706 (95%CI:1.170-2.489), respectively. The ROC curve analysis results showed that the area under the curve (AUC) of serum CRP and D-dimer alone for predicting the risk of death within 28 days in ICU patients with pulmonary tuberculosis were 0.765 (95%CI:0.670-0.861) and 0.775 (95%CI:0.681-0.870), with cutoff values of 87.845 mg/L and 4.375 μg/ml, respectively; the combined detection of both serum CRP and D-dimer had the highest AUC of 0.833 (95%CI:0.752-0.914) for predicting the risk of death. Conclusion: The levels of serum CRP and D-dimer have certain predictive value for the prognosis of pulmonary tuberculosis patients in the ICU, and the combined detection of the two has a higher predictive efficacy.

Key words: Tuberculosis, pulmonary, Critical illness, C-reactive protein, Fibrin, Prognosis