Pulmonary tuberculosis with acute respiratory failure

• Published in: The European respiratory journal Vol. 32; no. 6; pp. 1625 - 1630
• Main Authors: Kim, Y. J, Pack, K. M, Jeong, E, Na, J. O, Oh, Y-M, Lee, S. D, Kim, W. S, Kim, D. S, Kim, W. D, Shim, T. S
• Format: Journal Article
• Language: English
• Published: Leeds Eur Respiratory Soc 01.12.2008; Maney
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumology; Pneumonia - complications; Pneumonia - diagnosis; Respiration, Artificial; Respiratory Insufficiency - complications; Respiratory Insufficiency - diagnosis; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Treatment Outcome; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Miliary - complications; Tuberculosis, Miliary - diagnosis; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - diagnosis; Lung disease; Corticosteroid; Prognosis; Corticosteroids; Respiratory disease; Mortality; Pulmonary tuberculosis; tuberculosis; prognostic factors; Mycobacterial infection; Acute respiratory insufficiency; Epidemiology; Infection; Respiratory failure; Bacteriosis; Pneumology
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/09031936.00070907

The aim of the present study was to evaluate the clinical characteristics, prognoses and predictors of mortality of patients with pulmonary tuberculosis (TB) with acute respiratory failure (ARF), and to investigate the adjunctive use of corticosteroids in such cases. TB patients with ARF requiring mechanical ventilation (n = 90) were enrolled retrospectively during 1989-2006. The patients were divided into two groups: tuberculous pneumonia (TBP; n = 66), and miliary TB (MTB; n = 24). The TBP patients were older than the MTB patients (mean age 68.0 versus 54.5 yrs), and the mean+/-SD interval from hospital admission to start of anti-TB treatment was longer for the TBP than for the MTB group (5.0+/-7.0 versus 2.8+/-2.5 days). However, there was no difference in in-hospital mortality rate between the two groups (68.2 versus 58.3%). In the TBP patients, multivariate analysis showed that advanced age and shock unrelated to sepsis were associated with poor outcomes. Even though corticosteroid use was a predictor of survival in TBP patients, it was difficult to conclusively determine the efficacy of corticosteroids in TBP with ARF because of the retrospective study design. The present study reveals the need for randomised controlled trials to clarify the role of corticosteroids as adjunctive therapy in the management of tuberculous pneumonia with acute respiratory failure.