Aim of the work: there are limited data regarding active pulmonary tuberculosis (APTB) patients requiring ICU admission.This study aimed to determine the mortality rate and risk factors associated with TB patients with comorbidities requiring respiratory intensive care unit (RICU) admission. Patients and methods: a combined retrospective-prospective study was conducted from November 2014 to October 2016 and from November 2016 to April 2017 on adult patients with APTB admit to the RICU of Abbassia Chest Hospital for a period of more than 24 h. Demographic, clinical and therapeutics characteristics as well as outcome (RICU morality) were obtained from the medical records. Results: in this study a total of 43 patients were considered (median age 45 years for non survived patients and 36 years for survived patients). The RICU morality rate was 81.4%. Respiratory failure was the most common cause of admission to RICU 37,2% (16 patient). Mechanical ventilation (MV) was needed in 69.8% of patients (30 patients). Death rate in the diabetic patients was14.29%, in patients with renal disease it was 20% , in case of HIVit was 17.14% and in case of malignancy it was 8.57%.There was highly significant mortality rate accompanying LCF and the ratio was 31.43%,in case of respiratory failure type II it was 94.28% and in mechanical ventilation it was 80%. Non survived patients had high significant  APACHE SCORE 21.4±6.2 and the main cause of death was mainly ventilatory 80%(28 patients). Conclusion: the present study showed a very high mortality rate among TB patients with comorbidities requiring respiratory intensive care unit (RICU) admission and identified associated co morbidities, risk factors and a predictor of RICU mortality.