Tuberc Respir Dis.  2018 Jul;81(3):247-255. 10.4046/trd.2017.0126.

Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation

• Kim WY
• Kim MH
• Jo EJ
• Eom JS
• Mok J
• Kim KU
• Park HK
• Lee MK
• Lee K

• KMID: 2414568
• DOI: http://doi.org/10.4046/trd.2017.0126

Abstract

BACKGROUND
Patients with acute respiratory failure secondary to tuberculous destroyed lung (TDL) have a poor prognosis. The aim of the present retrospective study was to develop a mortality prediction model for TDL patients who require mechanical ventilation.
METHODS
Data from consecutive TDL patients who had received mechanical ventilation at a single university-affiliated tertiary care hospital in Korea were reviewed. Binary logistic regression was used to identify factors predicting intensive care unit (ICU) mortality. A TDL on mechanical Ventilation (TDL-Vent) score was calculated by assigning points to variables according to β coefficient values.
RESULTS
Data from 125 patients were reviewed. A total of 36 patients (29%) died during ICU admission. On the basis of multivariate analysis, the following factors were included in the TDL-Vent score: age ≥65 years, vasopressor use, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio <180. In a second regression model, a modified score was then calculated by adding brain natriuretic peptide. For TDL-Vent scores 0 to 3, the 60-day mortality rates were 11%, 27%, 30%, and 77%, respectively (p<0.001). For modified TDL-Vent scores 0 to ≥3, the 60-day mortality rates were 0%, 21%, 33%, and 57%, respectively (p=0.001). For both the TDL-Vent score and the modified TDL-Vent score, the areas under the receiver operating characteristic curve were larger than that of other illness severity scores.
CONCLUSION
The TDL-Vent model identifies TDL patients on mechanical ventilation with a high risk of mortality. Prospective validation studies in larger cohorts are now warranted.

Keyword

Mechanical Ventilation; Mortality; Prognosis; Risk; Tuberculosis

MeSH Terms

Cohort Studies
Humans
Intensive Care Units
Korea
Logistic Models
Lung*
Mortality*
Multivariate Analysis
Natriuretic Peptide, Brain
Oxygen
Partial Pressure
Prognosis
Prospective Studies
Respiration, Artificial*
Respiratory Insufficiency
Retrospective Studies
ROC Curve
Tertiary Healthcare
Tuberculosis
Natriuretic Peptide, Brain
Oxygen

Figure

• 

  Figure 1 Kaplan-Meier survival curves, as stratified according to the TDL-Vent score (A) and the modified TDL-Vent score (B). TDL-Vent: tuberculous destroyed lung on mechanical ventilation; ICU: intensive care unit.

• 

  Figure 2 Receiver operating characteristic curves of the TDL-Vent, APACHE II, and SOFA scores for predicting ICU mortality. TDL-Vent: tuberculous destroyed lung on mechanical ventilation; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; ICU: intensive care unit; AUC: area under the receiver operating characteristic curve.

• 

  Figure 3 Receiver operating characteristic curves of the modified TDL-Vent, APACHE II, and SOFA scores for predicting ICU mortality. TDL-Vent: tuberculous destroyed lung on mechanical ventilation; APACHE: Acute Physiology and Chronic Health Evaluation; SOFA: Sequential Organ Failure Assessment; ICU: intensive care unit; AUC: area under the receiver operating characteristic curve.

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