Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: a retrospective study in Chongqing, China

BMC Infectious Diseases

Dao Xin Wang²  Jin Tong²  ChangYi Li²  Jia Deng²  Yong Wang³  Gang Chen⁴  Liang An Hu⁵  Hilary Ma¹  Min Yu²  Wang Deng² 

[1] Department of Medicine, New York University Langone Medical Center, New York, USA;Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China;Department of Respiratory Medicine, Chongqing Pulmonary Hospital, Chongqing, China;Department of Respiratory Medicine, Chongqing Chest Hospital, Chongqing, China;Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China

关键词: China;    Predictors;    Miliary tuberculosis;    Acute respiratory distress syndrome;   

Others  :  1175370
DOI  :  10.1186/1471-2334-12-121

 received in 2011-09-16, accepted in 2012-05-20,  发布年份 2012

【 摘 要 】

Background

Miliary tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS) with a high mortality. The aim of the present study was to evaluate the clinical characteristics, predictors and outcome of patients with ARDS caused by miliary TB.

Methods

A retrospective study was conducted among patients with a diagnosis of ARDS with miliary TB in four hospitals from 2006 to 2010. Medical records and laboratory examinations of these patients were taken during the first 24 h of admission.

Results

Eighty-five patients with miliary TB developed ARDS, 45 of whom survived (52.9%). The median age was 36.6 ± 12.5 years with 38 males (44.7%). Diabetes mellitus (DM) was the most common underlying disease (18.8%).ICU mortality was 47.1%. The time from admission to anti-tuberculosis therapy was 4.5 ± 2.0 days. Mean duration of mechanical ventilation was 8.5 ± 3.0 days in all patients. Duration of time to diagnosis, time from diagnosis to mechanical ventilation, and time to anti-tuberculosis therapy were significantly shorter in survivors than those in non-survivors. Diabetes mellitus (OR 5.431, 95%CI 1.471-20.049; P = 0.005), ALT (70-100U/L, OR 10.029, 95%CI 2.764-36.389; P = 0.001), AST (>94U/L,OR 8.034, 95%CI 2.200-29.341; P = 0.002), D-dimer (>1.6mg/L, OR 3.167, 95%CI 0.896-11.187; P = 0.042), hemoglobin (<90g/L, OR 14.824, 95%CI 3.713-59.179; P = 0.001), albumin (<25g/L, OR 15.896, 95%CI 3.975-63.566; P = 0.001) were independent predictors of ARDS development in the setting of miliary TB.

Conclusions

Accurate diagnosis, early initiation of anti-tuberculosis therapy and mechanical ventilation are important for the outcome of patients with ARDS caused by miliary TB. DM, ALT, AST, D-dimer, hemoglobin, and albumin are independent predictors of ARDS development in patients with miliary TB.

【 授权许可】

   
2012 Deng et al.; licensee BioMed Central Ltd.

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