Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation

• Published in: Tuberculosis and respiratory diseases Vol. 81; no. 3; pp. 247 - 255
• Main Authors: Kim, Won-Young, Kim, Mi-Hyun, Jo, Eun-Jung, Eom, Jung Seop, Mok, Jeongha, Kim, Ki Uk, Park, Hye-Kyung, Lee, Min Ki, Lee, Kwangha
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Tuberculosis and Respiratory Diseases 01.07.2018; 대한결핵및호흡기학회
• Subjects: Original; 내과학; Risk; Prognosis; Tuberculosis; Mortality; Mechanical Ventilation
• ISSN: 1738-3536; 2005-6184
• DOI: 10.4046/trd.2017.0126

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. 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. 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. 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.