Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation
Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation
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DOI：
10.5588/ijtld.15.0690
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发表时间：
2016-04-01
影响因子：
4
通讯作者：
Han, S-S.
中科院分区：
文献类型：
--
作者：
Kim, S.;Kim, H.;Han, S-S.
目的：分析因肺结核 (TB) 导致的呼吸衰竭而接受机械通气 (MV) 的患者的预测因素和死亡率。设计：我们回顾性比较了因肺结核 (TB) 需要机械通气 (MV) 的患者与因社区获得性肺炎 (CAP) 需要机械通气 (MV) 的患者。结果：两组之间的院内死亡率存在显着差异：TB 组为 95.1%，CAP 组为 62.7%（P < 0.001，使用chi(2) 检验）。结核病患者的 30 天死亡率较高（使用对数秩检验，P = 0.040），尽管结核病和结核病患者的中位序贯器官衰竭评估 (SOFA)（7.0 vs. 6.0，P = 0.842）和平均急性生理学和慢性健康评估 (APACHE) II 评分（20.0 +/- 6.7 vs. 21.2 +/- 6.7，P = 0.379） CAP 患者没有什么不同。结核病患者更有可能出现肺部病变侵入增加（OR 1.307，95%CI 1.042-1.641，P = 0.021）和白蛋白减少（OR 0.073，95%CI 0.016-0.335，P = 0.001）、C反应蛋白（OR 0.324，95%CI 0.146-0.716，P = 0.005）和 CURB-65 评分（意识模糊、尿毒症、呼吸频率、血压和年龄 >= 65 岁）（OR 0.916，95%CI 0.844-0.995，P = 0.037）。结论：结核病患者的 SOFA 和 APACHE II 评分相同，但死亡率高于 CAP 患者。较高的死亡率与严重程度无关，但表明与破坏性肺部病变的程度有关。
OBJECTIVE: To analyse the predictors and mortality rate among patients receiving mechanical ventilation (MV) for respiratory failure due to pulmonary tuberculosis (TB).DESIGN: We retrospectively compared patients who required MV for TB with patients who required MV for community-acquired pneumonia (CAP).RESULTS: In-hospital mortality was significantly different between the two groups: 95.1% in TB vs. 62.7% in CAP (P < 0.001 using the chi(2) test). TB patients had a higher 30-day mortality (P = 0.040 using log-rank test), although the median sequential organ failure assessment (SOFA) (7.0 vs. 6.0, P = 0.842) and mean Acute Physiology and Chronic Health Evaluation (APACHE) II scores (20.0 +/- 6.7 vs. 21.2 +/- 6.7, P = 0.379) for TB and CAP patients were not different. TB patients were more likely to have increased lung lesion intrusions (OR 1.307, 95%CI 1.042-1.641, P = 0.021), and reduced albumin (OR 0.073, 95%CI 0.016-0.335, P = 0.001), C-reactive protein (OR 0.324, 95 %CI 0.146-0.716, P = 0.005) and CURB-65 score (confusion, uraemia, respiratory rate, blood pressure and age >= 65 years) (OR 0.916, 95%CI 0.844-0.995, P = 0.037).CONCLUSIONS: TB patients showed identical SOFA and APACHE II scores, but higher mortality than CAP patients. The higher mortality was not related to severity, but suggested an association with the extent of destructive lung lesions.