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KMID : 1044520180810030247
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Tuberculosis and Respiratory Diseases
2018 Volume.81 No. 3 p.247 ~ p.255
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Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation
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Kim Won-Young
Kim Mi-Hyun
Jo Eun-Jung
Eom Jung-Seop
Mok Jeong-Ha
Kim Ki-Uk
Park Hye-Kyung
Lee Min-Ki
Lee Kwang-Ha
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Abstract
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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.
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KEYWORD
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Mechanical Ventilation, Mortality, Prognosis, Risk, Tuberculosis
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