Abstract Introduction Tuberculosis (TB) requiring invasive mechanical ventilation is uncommon but associated with high mortality. Despite global progress in TB control, outcomes among critically ill TB patients remain poorly characterized in modern U.S. hospital cohorts. Identifying predictors of mortality may improve early triage, resource allocation, and treatment strategies for this vulnerable population. Methods A retrospective analysis was conducted using the 2021 National Inpatient Sample (NIS). Adult patients (≥18 years) with ICD-10 codes for tuberculosis (A15*, A16*) who underwent invasive mechanical ventilation (5A1935Z, 5A1945Z, 5A1955Z) were included. To capture disease severity, cases with concomitant sepsis (A41*), acute respiratory distress syndrome (J80), or HIV infection (B20-B24) were retained. The primary outcome was in-hospital mortality. Logistic regression was performed to identify independent predictors using age, sex, primary payer, length of stay, and total hospital charges as covariates. Model calibration was assessed with the Hosmer-Lemeshow test and discrimination with the area under the receiver operating characteristic curve (AUC). Results A total of 1,046 hospitalizations met inclusion criteria, of which 7.5% (n = 76) resulted in in-hospital death. In the multivariable model (n = 885 complete cases), older age was independently associated with higher mortality (odds ratio OR 1.05 per year; p 0.001). Compared with privately insured patients, mortality risk was greater among those with Medicaid (OR 4.21; p 0.001) and other or unknown payer types (OR 29.9; p 0.001). Sex, length of stay, and total charges were not significant predictors. The model demonstrated good calibration (Hosmer-Lemeshow p = 0.628) and strong discriminatory ability (AUC = 0.803). Discussion Mortality among mechanically ventilated TB patients remains substantial, with outcomes influenced by both clinical and socioeconomic factors. The strong association between payer status and mortality highlights the impact of healthcare access disparities and possible delays in care for under-insured populations. These findings align with prior studies linking social vulnerability to worse outcomes in critical illness but emphasize an even greater effect among TB patients requiring mechanical ventilation. Conclusion Invasive mechanical ventilation in TB carries a significant risk of death. Age and insurance-related disparities were the strongest predictors of mortality. Efforts to improve early critical care access and address systemic inequities may reduce preventable deaths among patients with severe TB. This abstract is funded by: None
Levy et al. (Fri,) studied this question.