Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis

Int J Tuberc Lung Dis. 2006 Apr;10(4):429-35.

Abstract

Objective: To study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB).

Methods: Retrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB.

Results: Of 2733 TB patients treated during 1980-2003, 29 (1.06%; 1.21 patients/year; mean age 31.6 +/- 10.9 years; 16 males) developed ARDS (cases). Seven had pulmonary TB and 22 had miliary TB (MTB); 298 (mean age 32.0 +/- 14.2 years; 110 males) who did not develop ARDS constituted controls. Presence of MTB (OR 4.6, 95%CI 1.2-17.8; P = 0.02), duration of illness beyond 30 days at presentation (OR 177.9, 95%CI 39-811.7; P < 0.001), absolute lymphocyte count < 1625/ mm3 (OR 4.5, 95%CI 1.1-19.3; P = 0.04) and serum ALT > 100 IU (OR 15.7, 95%CI 3.0-81.1, P < 0.001) were independent predictors of ARDS development. Twelve cases died (41.4%). Patients with APACHE II score >18; those with APACHE II score <18 in the presence of hyponatraemia and PaO2/FIO2 ratio <108.5 were likely to die.

Conclusions: In patients with TB, prolonged illness, MTB, absolute lymphocytopaenia and elevated ALT are independently associated with ARDS development. APACHE II score, serum sodium and PaO2/FIO2 ratio are determinants of outcome.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Disease Progression
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • India / epidemiology
  • Male
  • Prognosis
  • Respiratory Distress Syndrome, Adult / epidemiology
  • Respiratory Distress Syndrome, Adult / etiology*
  • Retrospective Studies
  • Risk Factors
  • Tuberculosis, Pulmonary / complications*
  • Tuberculosis, Pulmonary / epidemiology