title: Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: a retrospective study in Chongqing, China.
abstract: BACKGROUND
  Miliary tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS) with a high mortality. The aim of the present study was to evaluate the clinical characteristics, predictors and outcome of patients with ARDS caused by miliary TB.
  
  
  METHODS
  A retrospective study was conducted among patients with a diagnosis of ARDS with miliary TB in four hospitals from 2006 to 2010. Medical records and laboratory examinations of these patients were taken during the first 24 h of admission.
  
  
  RESULTS
  Eighty-five patients with miliary TB developed ARDS, 45 of whom survived (52.9%). The median age was 36.6 ± 12.5 years with 38 males (44.7%). Diabetes mellitus (DM) was the most common underlying disease (18.8%).ICU mortality was 47.1%. The time from admission to anti-tuberculosis therapy was 4.5 ± 2.0 days. Mean duration of mechanical ventilation was 8.5 ± 3.0 days in all patients. Duration of time to diagnosis, time from diagnosis to mechanical ventilation, and time to anti-tuberculosis therapy were significantly shorter in survivors than those in non-survivors. Diabetes mellitus (OR 5.431, 95%CI 1.471-20.049; P = 0.005), ALT (70-100U/L, OR 10.029, 95%CI 2.764-36.389; P = 0.001), AST (>94U/L,OR 8.034, 95%CI 2.200-29.341; P = 0.002), D-dimer (>1.6mg/L, OR 3.167, 95%CI 0.896-11.187; P = 0.042), hemoglobin (<90g/L, OR 14.824, 95%CI 3.713-59.179; P = 0.001), albumin (<25g/L, OR 15.896, 95%CI 3.975-63.566; P = 0.001) were independent predictors of ARDS development in the setting of miliary TB.
  
  
  CONCLUSIONS
  Accurate diagnosis, early initiation of anti-tuberculosis therapy and mechanical ventilation are important for the outcome of patients with ARDS caused by miliary TB. DM, ALT, AST, D-dimer, hemoglobin, and albumin are independent predictors of ARDS development in patients with miliary TB.
authors.affiliation: Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Deng
authors.forename: Min
authors.initials: M
authors.lastname: Yu
authors.forename: Hilary
authors.initials: H
authors.lastname: Ma
authors.forename: Liang An
authors.initials: LA
authors.lastname: Hu
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Jia
authors.initials: J
authors.lastname: Deng
authors.forename: ChangYi
authors.initials: C
authors.lastname: Li
authors.forename: Jin
authors.initials: J
authors.lastname: Tong
authors.forename: Dao Xin
authors.initials: DX
authors.lastname: Wang
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000418:Albumins / Q000378:metabolism; D000995:Antitubercular Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002681:China; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D011379:Prognosis; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014391:Tuberculosis, Miliary / Q000150:complications*
chemical_list: D000418:Albumins; D000995:Antitubercular Agents; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D006454:Hemoglobins; C036309:fibrin fragment D; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase