Effects of Corticosteroids on Critically Ill Pulmonary Tuberculosis Patients With Acute Respiratory Failure: A Propensity Analysis of Mortality

Yang, Ji; Han, Minkyu; Koh, Younsuck; Kim, Woo-Sung; Song, Jin-Woo; Oh, Yeon‐Mok; Lee, Sangdo; Lee, Sei Won; Lee, Jae Seung; Lim, Chae‐Man; Choi, Chang‐Min; Huh, Jae-Wan; Hong, Sang‐Bum; Shim, Tae Sun; Jo, Kyung-Wook

doi:10.1093/cid/ciw616

Cited by 29 publications

(30 citation statements)

References 33 publications

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“…Of the included studies, 19 studies were from high tuberculosis burden countries. 2,3,[5][6][7]18,19,[22][23][24][26][27][28]31,35,37,39,42,43 One study each exclusively included subjects who were critically ill with chronic kidney disease 29 or with human immunodeficiency virus 42 and affected with tuberculosis. Six studies included only subjects with tuberculosis-related ARDS.…”

Section: Resultsmentioning

confidence: 99%

“…com). 1,5,6,18,21,[23][24][25]27,28,31,40,41,43,44 The common indications for the use of glucocorticoids were miliary tuberculosis, respiratory failure, ARDS, and shock. Eight studies compared mortality in subjects with and without glucocorticoids (Supplemental Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies compared mortality in subjects with and without glucocorticoids (Supplemental Table 2). 1,5,24,27,28,40,43,44 Only one study provided the details of dose and duration of glucocorticoids (methylprednisolone, 80 mg/d for 5 d) used. 5…”

Section: Resultsmentioning

confidence: 99%

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Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis

et al. 2018

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“…A combination of tuberculosis drugs must be given. There is some suggestion that steroid therapy might decrease mortality in critically ill patients with tuberculosis and ARF, although further data are needed [45]. Mortality rates in patients with tuberculosis and ARF have ranged from 50 to 70% [46].…”

Section: Mycobacterial Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

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“…The first-line regimen for suspected or definite pulmonary tuberculosis is shown in Table 1. Whether adjunctive corticosteroids exert a beneficial outcome effect in HIV-infected patients with tuberculosis-induced ARF remains to be investigated [69,70].…”

Section: Common Aids-defining Diagnoses In the Icumentioning

confidence: 99%

Management of HIV-infected patients in the intensive care unit

et al. 2020

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The widespread use of combination antiretroviral therapies (cART) has converted the prognosis of HIV infection from a rapidly progressive and ultimately fatal disease to a chronic condition with limited impact on life expectancy. Yet, HIV-infected patients remain at high risk for critical illness due to the occurrence of severe opportunistic infections in those with advanced immunosuppression (i.e., inaugural admissions or limited access to cART), a pronounced susceptibility to bacterial sepsis and tuberculosis at every stage of HIV infection, and a rising prevalence of underlying comorbidities such as chronic obstructive pulmonary diseases, atherosclerosis or non-AIDS-defining neoplasms in cART-treated patients aging with controlled viral replication. Several patterns of intensive care have markedly evolved in this patient population over the late cART era, including a steady decline in AIDS-related admissions, an opposite trend in admissions for exacerbated comorbidities, the emergence of additional drivers of immunosuppression (e.g., anti-neoplastic chemotherapy or solid organ transplantation), the management of cART in the acute phase of critical illness, and a dramatic progress in short-term survival that mainly results from general advances in intensive care practices. Besides, there is a lack of data regarding other features of ICU and post-ICU care in these patients, especially on the impact of sociological factors on clinical presentation and prognosis, the optimal timing of cART introduction in AIDS-related admissions, determinants of end-of-life decisions, long-term survival, and functional outcomes. In this narrative review, we sought to depict the current evidence regarding the management of HIV-infected patients admitted to the intensive care unit.

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Effects of Corticosteroids on Critically Ill Pulmonary Tuberculosis Patients With Acute Respiratory Failure: A Propensity Analysis of Mortality

Abstract: The study results showed that corticosteroids could reduce the 90-day mortality rate in critically ill pulmonary tuberculosis patients with ARF.

Cited by 29 publications

References 33 publications

Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis

Outcome of Critically Ill Subjects With Tuberculosis: Systematic Review and Meta-Analysis

Diagnosis of severe respiratory infections in immunocompromised patients

Management of HIV-infected patients in the intensive care unit

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