Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation

초록

OBJECTIVE: To analyse the predictors and mortality rate among patients receiving mechanical ventilation (MV) for respiratory failure due to pulmonary tuberculosis (TB). DESIGN: We retrospectively compared patients who required MV for TB with patients who required MV for community-acquired pneumonia (CAP). RESULTS: In-hospital mortality was significantly different between the two groups: 95.1% in TB vs. 62.7% in CAP (P < 0.001 using the chi(2) test). TB patients had a higher 30-day mortality (P = 0.040 using log-rank test), although the median sequential organ failure assessment (SOFA) (7.0 vs. 6.0, P = 0.842) and mean Acute Physiology and Chronic Health Evaluation (APACHE) II scores (20.0 +/- 6.7 vs. 21.2 +/- 6.7, P = 0.379) for TB and CAP patients were not different. TB patients were more likely to have increased lung lesion intrusions (OR 1.307, 95%CI 1.042-1.641, P = 0.021), and reduced albumin (OR 0.073, 95%CI 0.016-0.335, P = 0.001), C-reactive protein (OR 0.324, 95 %CI 0.146-0.716, P = 0.005) and CURB-65 score (confusion, uraemia, respiratory rate, blood pressure and age >= 65 years) (OR 0.916, 95%CI 0.844-0.995, P = 0.037). CONCLUSIONS: TB patients showed identical SOFA and APACHE II scores, but higher mortality than CAP patients. The higher mortality was not related to severity, but suggested an association with the extent of destructive lung lesions.

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