• Int. J. Tuberc. Lung Dis. · Apr 2006

    Comparative Study

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

    • S K Sharma, A Mohan, A Banga, P K Saha, and K K Guntupalli.
    • Department of Medicine, Division of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India. sksharma@aiims.ac.in
    • Int. J. Tuberc. Lung Dis. 2006 Apr 1; 10 (4): 429-35.

    ObjectiveTo study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB).MethodsRetrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB.ResultsOf 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.ConclusionsIn 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.

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