title: Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma@aiims.ac.in
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.forename: A
authors.initials: A
authors.lastname: Mohan
authors.forename: A
authors.initials: A
authors.lastname: Banga
authors.forename: P K
authors.initials: PK
authors.lastname: Saha
authors.forename: K K
authors.initials: KK
authors.lastname: Guntupalli
mesh_terms: 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