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Tuberculosis & Respiratory Diseases

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Vol.81 No.3
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Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2018, v.81 no.3, pp.247-255









& (2018). Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation. Tuberculosis & Respiratory Diseases, 81(3), 247-255.
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Abstract

Background: Patients with acute respiratory failure secondary to tuberculous destroyed lung (TDL) have a poor prognosis. The aim of the present retrospective study was to develop a mortality prediction model for TDL patients who require mechanical ventilation. Methods: Data from consecutive TDL patients who had received mechanical ventilation at a single university-affiliated tertiary care hospital in Korea were reviewed. Binary logistic regression was used to identify factors predicting intensive care unit (ICU) mortality. A TDL on mechanical Ventilation (TDL-Vent) score was calculated by assigning points to variables according to β coefficient values. Results: Data from 125 patients were reviewed. A total of 36 patients (29%) died during ICU admission. On the basis of multivariate analysis, the following factors were included in the TDL-Vent score: age ≥65 years, vasopressor use, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio <180. In a second regression model, a modified score was then calculated by adding brain natriuretic peptide. For TDL-Vent scores 0 to 3, the 60-day mortality rates were 11%, 27%, 30%, and 77%, respectively (p<0.001). For modified TDL-Vent scores 0 to ≥3, the 60-day mortality rates were 0%, 21%, 33%, and 57%, respectively (p=0.001). For both the TDL-Vent score and the modified TDL-Vent score, the areas under the receiver operating characteristic curve were larger than that of other illness severity scores. Conclusion: The TDL-Vent model identifies TDL patients on mechanical ventilation with a high risk of mortality. Prospective validation studies in larger cohorts are now warranted.

keywords
Mechanical Ventilation, Mortality, Prognosis, Risk, Tuberculosis

Reference

1.

Bobrowitz ID, Rodescu D, Marcus H, Abeles H. The destroyed tuberculous lung. Scand J Respir Dis 1974;55:82-8.

2.

Park JH, Na JO, Kim EK, Lim CM, Shim TS, Lee SD, et al. The prognosis of respiratory failure in patients with tuberculous destroyed lung. Int J Tuberc Lung Dis 2001;5:963-7.

3.

Ryu YJ, Koh WJ, Kang EH, Suh GY, Chung MP, Kim H, et al. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology 2007;12:406-11.

4.

Ryu YJ, Lee JH, Chun EM, Chang JH, Shim SS. Clinical outcomes and prognostic factors in patients with tuberculous destroyed lung. Int J Tuberc Lung Dis 2011;15:246-50.

5.

Chakhaia T, Magee MJ, Kempker RR, Gegia M, Goginashvili L, Nanava U, et al. High utility of contact investigation for latent and active tuberculosis case detection among the contacts: a retrospective cohort study in Tbilisi, Georgia, 2010-2011. PLoS One 2014;9:e111773.

6.

Calligaro GL, Theron G, Khalfey H, Peter J, Meldau R, Mat- inyenya B, et al. Burden of tuberculosis in intensive care units in Cape Town, South Africa, and assessment of the accuracy and effect on patient outcomes of the Xpert MTB/RIF test on tracheal aspirate samples for diagnosis of pulmonary tuberculosis: a prospective burden of disease study with a nested randomised controlled trial. Lancet Respir Med 2015;3:621- 30.

7.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-29.

8.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.

9.

Wong KT, Antonio GE, Hui DS, Lee N, Yuen EH, Wu A, et al. Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients. Radiology 2003;228:401-6.

10.

Muller NL, Ooi GC, Khong PL, Nicolaou S. Severe acute respiratory syndrome: radiographic and CT findings. AJR Am J Roentgenol 2003;181:3-8.

11.

Choi JK, Paek D, Lee JO. Normal predictive values of spirometry in Korean population. Tuberc Respir Dis 2005;58:230-42.

12.

Weitzenblum E. Chronic cor pulmonale. Heart 2003;89:225-30.

13.

Arcasoy SM, Christie JD, Ferrari VA, Sutton MS, Zisman DA, Blumenthal NP, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 2003;167:735-40.

14.

Cleveland WS, Grosse E, Shyu WM. Local regression models. In: Chambers JM, Hastie TJ, editors. Statistical models in S. Pacific Grove: Wadsworth & Brooks/Cole; 1992. p. 309-76.

15.

Perkins NJ, Schisterman EF. The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 2006;163:670-5.

16.

Bishop JM, Cross KW. Physiological variables and mortality in patients with various categories of chronic respiratory disease. Bull Eur Physiopathol Respir 1984;20:495-500.

17.

Lee JH, Chang JH. Lung function in patients with chronic airflow obstruction due to tuberculous destroyed lung. Respir Med 2003;97:1237-42.

18.

Chaouat A, Naeije R, Weitzenblum E. Pulmonary hyperten- sion in COPD. Eur Respir J 2008;32:1371-85.

19.

Benza RL, Miller DP, Gomberg-Maitland M, Frantz RP, Fore- man AJ, Coffey CS, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation 2010;122:164-72.

20.

Lee PL, Jerng JS, Chang YL, Chen CF, Hsueh PR, Yu CJ, et al. Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation. Eur Respir J 2003;22:141-7.

21.

Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J 2006;27:1223-8.

22.

Kim S, Kim H, Kim WJ, Lee SJ, Hong Y, Lee HY, et al. Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation. Int J Tuberc Lung Dis 2016;20:524-9.

23.

Zahar JR, Azoulay E, Klement E, De Lassence A, Lucet JC, Regnier B, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med 2001;27:513-20.

24.

Jo YS, Park JH, Lee JK, Heo EY, Chung HS, Kim DK. Risk factors for pulmonary arterial hypertension in patients with tuberculosis-destroyed lungs and their clinical characteristics compared with patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017;12:2433-43.

25.

Song JW, Song JK, Kim DS. Echocardiography and brain natriuretic peptide as prognostic indicators in idiopathic pulmonary fibrosis. Respir Med 2009;103:180-6.

26.

Park SY, Lee CY, Kim C, Jang SH, Park YB, Park S, et al. One-year prognosis and the role of brain natriuretic peptide levels in patients with chronic cor pulmonale. J Korean Med Sci 2015;30:442-9.

27.

Rhee CK, Yoo KH, Lee JH, Park MJ, Kim WJ, Park YB, et al. Clinical characteristics of patients with tuberculosis-destroyed lung. Int J Tuberc Lung Dis 2013;17:67-75.

28.

Hnizdo E, Singh T, Churchyard G. Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. Thorax 2000;55:32-8.

29.

Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S, et al. Pulmonary impairment after tuberculosis. Chest 2007;131:1817-24.

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