Efficacy of steroid pulse therapy for miliary tuberculosis complicated by acute respiratory distress syndrome

Kentaro Wakamatsu; Nobuhiko Nagata; Hiroyuki Kumazoe; Satoshi Honjo; Minako Hamada; Kouta Katsuki; Makiko Hara; Aiko Nagaoka; Naotaka Noda; Ruriko Kiyotani; Izumi Fukui; Mizuko Ose; Katsuyuki Katahira; Takashi Akasaki; Sanae Maki; Miiru Izumi; Masayuki Kawasaki; Yasuko Harada

doi:10.1016/j.jctube.2022.100341

Efficacy of steroid pulse therapy for miliary tuberculosis complicated by acute respiratory distress syndrome

J Clin Tuberc Other Mycobact Dis. 2022 Nov 14:29:100341. doi: 10.1016/j.jctube.2022.100341. eCollection 2022 Dec.

Authors

Kentaro Wakamatsu¹, Nobuhiko Nagata², Hiroyuki Kumazoe³, Satoshi Honjo⁴, Minako Hamada⁵, Kouta Katsuki⁶, Makiko Hara¹, Aiko Nagaoka¹, Naotaka Noda¹, Ruriko Kiyotani¹, Izumi Fukui¹, Mizuko Ose¹, Katsuyuki Katahira¹, Takashi Akasaki¹, Sanae Maki¹, Miiru Izumi¹, Masayuki Kawasaki¹, Yasuko Harada⁷

Affiliations

¹ Department of Respiratory Medicine, National Hospital Organization Omuta National Hospital, 1044-1 Oaza, Tachibana, Omuta City, Fukuoka 837-0911, Japan.
² Department of Respiratory Medicine, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka City, Fukuoka 814-0001, Japan.
³ Department of Radiology, National Hospital Organization Omuta National Hospital, 1044-1 Oaza, Tachibana, Omuta City, Fukuoka 837-0911, Japan.
⁴ Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru Minami-ku, Fukuoka City, Fukuoka 811-1394, Japan.
⁵ Department of Respiratory Medicine, National Hospital Organization Minamikyusyu National Hospital, 1882 Kida Kajiki-cho, Aira City, Kagoshima 899-5293 Japan.
⁶ Department of Clinical Laboratory, National Hospital Organization Omuta National Hospital, 1044-1 Oaza, Tachibana, Omuta City, Fukuoka 837-0911, Japan.
⁷ Department of Respiratory Medicine, Nishifukuoka Hospital, 3-18-8 Ikinomatsubara, Nisi-ku, Fukuoka City, Fukuoka 819-8555, Japan.

Abstract

Introduction: Acute respiratory distress syndrome (ARDS) is considered a poor prognostic factor for miliary tuberculosis (MTB), but little is known about the effectiveness of steroid pulse therapy for MTB complicated by ARDS.

Patients and methods: Medical records were used to retrospectively investigate the prognosis and clinical information of 13 patients diagnosed with MTB complicated by ARDS among 68 patients diagnosed with MTB at our hospital between January 1994 and October 2016. None of the patients had multidrug resistant tuberculosis (TB). MTB was diagnosed by 1 radiologist and 2 respiratory physicians based on the observation of randomly distributed, uniformly sized diffuse bilateral nodules on chest computed tomography and the detection of mycobacterium TB from clinical specimens. ARDS was diagnosed based on the Berlin definition of ARDS. The effect of steroid pulse therapy on death within 3 months of hospitalization was examined using Cox proportional hazards models. Variables were selected by the stepwise method (variable reduction method).

Results: Six of 8 patients with MTB complicated by ARDS were alive 3 months after hospitalization in the steroid pulse therapy group, whereas only 1 of 5 patients was alive in the non-steroid pulse therapy group. Analysis of factors related to the survival of patients with MTB complicated by ARDS revealed that steroid pulse therapy was the strong prognostic factor (hazard ratio = 0.136 (95 % CI: 0.023-0.815)).

Conclusion: Our findings suggest that steroid pulse therapy improves the short-term prognosis of patients with MTB complicated by ARDS.

Keywords: AFB, acid-fast bacilli; ALT, alanine transaminase; ARDS; ARDS, acute respiratory distress syndrome; AST, aspartate transaminase; Alb, albumin; BMI, body mass index; BUN, Blood urea nitrogen; CI, confidence interval; CRP, C-reactive protein; CT, computed tomography; DM, diabetes mellitus; FiO2, inspired oxygen fraction; Hb, hemoglobin; LDH, Lactate dehydrogenase; MGIT, Mycobacteria Growth Indicator Tube; MTB, Miliary tuberculosis; Miliary tuberculosis; PCR, polymerase chain reaction; PS, performance status; PaO2, partial pressure of arterial oxygen; SOFA, sequential organ failure assessment; Steroid pulse therapy; TB, tuberculosis; WBC, white blood cell.