Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure.
OBJECTIVE
The prognosis in patients with pulmonary tuberculosis and acute respiratory failure requiring mechanical ventilation is believed to be poor. The aim of this study was to identify factors contributing to in-hospital mortality in these patients.


METHODS
The medical records of 32 patients with active pulmonary tuberculosis as a primary cause of acute respiratory failure requiring mechanical ventilation in the medical intensive care unit (ICU) of a tertiary referral hospital over a 10-year period were reviewed retrospectively, and predictors of mortality were assessed.


RESULTS
The patients' median age was 69 years (range 25-88 years). The median length of intensive care unit stay was 11 days (range 2-88 days), and the median duration of mechanical ventilation was 9 days (range 2-86 days). Overall in-hospital mortality was 59% (19/32). Independent predictive factors of in-hospital mortality included tuberculous-destroyed lungs (hazard ratio 6.61, 95% CI: 1.21-36.04, P = 0.029), Acute Physiology and Chronic Health Evaluation II scores > or =20 (hazard ratio 4.90, 95% CI: 1.43-16.80, P = 0.012) and sepsis (hazard ratio 5.84, 95% CI: 1.63-20.95, P = 0.007).


CONCLUSIONS
Acute respiratory failure caused by pulmonary tuberculosis necessitating mechanical ventilation has a high mortality rate and poor prognosis, particularly in patients with tuberculous-destroyed lungs, high Acute Physiology and Chronic Health Evaluation II scores and sepsis.
Ryu
Yon Ju
YJ
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Koh
Won-Jung
WJ
Kang
Eun Hae
EH
Suh
Gee Young
GY
Chung
Man Pyo
MP
Kim
Hojoong
H
Kwon
O Jung
OJ
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality
D000995:Antitubercular Agents