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Nutritional deficit as a negative prognostic factor in patients with miliary tuberculosis

¹ Division of Pulmonology and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Boramae Hospital, ² Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine and Lung Institute, Seoul National University Hospital, and ³ Division of Pulmonology and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea.

CORRESPONDENCE: J-H. Lee, Dept of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Geonggi-do, 463-707, Republic of Korea. Fax: 82 317874052. E-mail: jhlee7{at}snubh.org

Keywords: Acute respiratory failure, malnutrition, miliary tuberculosis, prognosis

Received: December 23, 2007
Accepted May 2, 2008

The effects of malnutrition on outcomes in miliary tuberculosis (MTB) are not well described. The aim of the present study was to find predictors for the development of acute respiratory failure (ARF) and survival in MTB patients, focusing on parameters reflecting nutritional condition.

Out of the patients from three hospitals who had microbiologically or histopathologically confirmed tuberculosis, 56 patients presenting with typical disseminated pulmonary nodules on radiographs were retrospectively enrolled. A four-point nutritional risk score (NRS) was defined according to the presence of four nutritional factors: low body mass index (BMI; <18.5 kg·m^–2), hypoalbuminaemia (<30.0 g·L^–1), hypocholesterolaemia (<2.33 mmol·L^–1) and severe lymphocytopenia (<7x10⁵ cells·L^–1).

The male to female ratio was 1:3. ARF developed in 25% of patients (14 out of 56), with a 50% fatality rate. A high NRS (3 points) was an independent risk factor for the development of ARF and fatality. In 90-day survival analysis, ARF, severe lymphocytopenia, hypocholesterolaemia, low BMI and higher NRS were risk factors for poor outcome. In multivariate analysis, only high NRS was an independent risk factor for 90-day survival rate in patients with MTB.

A high nutritional risk score was a good predictor of poor outcome in miliary tuberculosis patients. Additional approaches to recover the nutritional deficits may become a focus in future management of miliary tuberculosis.

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