Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis.
OBJECTIVE
To study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB).


METHODS
Retrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB.


RESULTS
Of 2733 TB patients treated during 1980-2003, 29 (1.06%; 1.21 patients/year; mean age 31.6 +/- 10.9 years; 16 males) developed ARDS (cases). Seven had pulmonary TB and 22 had miliary TB (MTB); 298 (mean age 32.0 +/- 14.2 years; 110 males) who did not develop ARDS constituted controls. Presence of MTB (OR 4.6, 95%CI 1.2-17.8; P = 0.02), duration of illness beyond 30 days at presentation (OR 177.9, 95%CI 39-811.7; P < 0.001), absolute lymphocyte count < 1625/ mm3 (OR 4.5, 95%CI 1.1-19.3; P = 0.04) and serum ALT > 100 IU (OR 15.7, 95%CI 3.0-81.1, P < 0.001) were independent predictors of ARDS development. Twelve cases died (41.4%). Patients with APACHE II score >18; those with APACHE II score <18 in the presence of hyponatraemia and PaO2/FIO2 ratio <108.5 were likely to die.


CONCLUSIONS
In patients with TB, prolonged illness, MTB, absolute lymphocytopaenia and elevated ALT are independently associated with ARDS development. APACHE II score, serum sodium and PaO2/FIO2 ratio are determinants of outcome.
Sharma
S K
SK
Department of Medicine, Division of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma@aiims.ac.in
Mohan
A
A
Banga
A
A
Saha
P K
PK
Guntupalli
K K
KK
D000328:Adult; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000453:epidemiology