Pulmonary tuberculosis with acute respiratory failure in South Korea

¹ Division of Pulmonary and Critical Care Medicine
² University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

^* To whom correspondence should be addressed. E-mail: shimts{at}amc.seoul.kr.

	Abstract

This study evaluated the clinical characteristics, prognoses, and predictors of mortality in patients with pulmonary tuberculosis (TB) with acute respiratory failure (ARF), and investigated the adjunctive use of corticosteroids in such cases.

Ninety TB patients with ARF requiring mechanical ventilation were enrolled retrospectively from 1989 to 2006. The patients were divided into two groups: TB pneumonia (TBp, n=66) and miliary TB (TBm, n=24).

The TBp patients were older than the TBm patients (mean age 68.0 vs 54.5 years) and the mean interval from hospital admission to start of anti-TB treatment was longer for the TBp than for the TBm (5.0±7.0 vs 2.8±2.5 days). However, there was no difference in in-hospital mortality rates between the two groups (68.2% vs 58.3%). In TBp patients, multivariate analysis showed that advanced age and shock not related to sepsis were associated with poor outcomes. Even though corticosteroid use was a predictor of survival in TBp patients, it was difficult to conclusively determine the efficacy of corticosteroids in TBp with ARF because of the retrospective study design.

This study shows the need for randomized controlled trials to clarify the role of corticosteroids as adjunctive therapy in the management of TBp with ARF.

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