Mortality and Prognostic Factors in Acute Respiratory Distress Syndrome due to Tuberculosis

Kim, Tae Ok; Kang, Hyun Wook; Chi, Su Young; Ban, Hee Jung; Oh, In Jae; Kim, Kyu Sik; Kim, Yu Il; Lim, Sung Chul; Kim, Young Chul; Kwon, Yong Soo

Abstract

BACKGROUND/AIMS
Acute respiratory distress syndrome (ARDS) due to tuberculosis (TB) is a rare disease, but its mortality is believed to be high. The aim of this study was to evaluate the mortality rate and prognostic factors of ARDS.
METHODS
We retrospectively reviewed the demographic, clinical, radiologic, and laboratory data of 19 patients with ARDS due to active pulmonary TB at Chonnam National University Hospital between January 2000 and December 2010.
RESULTS
The median age of patients was 71.1 (interquartile range [IQR] 51-74) years. None had a history of TB treatment. The most common symptoms were dyspnea (90%), fever (68%), and cough (53%). The overall in-hospital mortality was 73%. The median acute physiologic assessment and chronic health evaluation (APACHE) III score and pneumonia severity index (PSI) were 81.9 (IQR 59.0-92.0) and 111.0 (IQR 77.0-131.0), respectively. The PSI was significantly higher in non-survivors than in survivors (55.0 vs. 122.0; p = 0.016). The rate of TB treatment before admission was significantly higher in survivors than in non-survivors (75% vs. 13%; p = 0.037). The time from admission to treatment initiation was significantly longer in non-survivors than in survivors (3 vs. 0 days; p = 0.049). The median duration of mechanical ventilation was 11 days (IQR 5-16 days). The most common cause of death was a refractory shock (53%).
CONCLUSIONS
The overall mortality rate of ARDS due to pulmonary TB was high. A high PSI score and delay of TB treatment may be risk factors for a poor outcome of ARDS due to pulmonary TB.