중환자실로 입원한 폐결핵 환자의 임상 양상과 예후 인자
Clinical Characteristics and Prognostic Factors in Patients with Pulmonary Tuberculosis Admitted to Intensive Care Units
김명숙 (가톨릭대학교)
김주상 (가톨릭대학교 의과대학 내과학교실)
강현희 (가톨릭대학교)
김승수 (가톨릭대학교)
김용현 (가톨릭대학교)
김진우 (가톨릭대학교)
김석찬 (가톨릭대학교)
문화식 (가톨릭대학교)
이상학 (가톨릭대학교)
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Abstract
Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17∼87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.
- keywords
- Tuberculosis, Pulmonary, Intensive Care, Nutritional Status, Respiratory Insufficiency, Tuberculosis, Pulmonary, Intensive Care, Nutritional Status, Respiratory Insufficiency
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