Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: a retrospective study in Chongqing, China

Abstract

BackgroundMiliary 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.MethodsA 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.ResultsEighty-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.ConclusionsAccurate 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.

Factors associated with mortality among patients with active pulmonary tuberculosis requiring intensive care

“…These were comparable to the mortality rates (range 47%-65.7%) reported from China, (9) Taiwan, (8) Korea (5) and Brazil. (13) Other centres have reported lower mortality rates in the range of 20%-30%.…”

“…(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) Identified risk factors for mortality include acute respiratory distress syndrome, (4,5) need for mechanical ventilation, (4) HIV infection, (7) multiple organ failure, (3,5) consolidation on chest radiograph, (3,5) acute renal failure, (4) early ICU admission, (13) Acute Physiology and Chronic Health Evaluation (APACHE) II score, (6) Sequential Organ Failure Assessment (SOFA) score, (14) sepsis, (4,6) low albumin, (7) age (15) and nosocomial-or ventilator-associated pneumonia. (4,8,13) Besides these factors, treating PTB in the ICU is challenging because of poor absorption of antituberculous treatment among the critically ill and the paradoxical deterioration of TB during treatment.…”

Clinical Analysis of Miliary Tuberculosis Patients in Our Tertiary Hospital

“…Although there are a few reports suggesting that the administration of corticosteroid drugs is effective for the treatment of ARDS complicated with miliary TB [15] [16] [17], they were not effective for case 6 in this study. Therefore, we have some doubts regarding the effectiveness of corticosteroid drugs administration for miliary TB.…”

Miliary tuberculosis in an immunocompetent male with a fatal outcome

“…Mohan's paper aptly highlights the difficulties encountered in diagnosing miliary TB as a primary cause of ARDS 7. Other reported respiratory complications include pneumomediastinum and acute empyema 8. In the acute phase, arterial hypoxaemia due to widening of the alveolar–arterial oxygen gradient and hypercapnia due to tachypnoea are also observed 9.…”