Acute respiratory distress syndrome (ARDS) is a rare complication of pulmonary tuberculosis (PTB). Most of the data regarding this entity are limited to case reports. Predictors of mortality for these patients have not been described previously.
We retrospectively evaluated 18 patients with ARDS secondary to PTB (age 33.3 ± 11.3 yrs, M:F 9:9) seen over a 13-year period (1991–2003). Diagnosis of ARDS was based on standard guidelines. All patients had microbiological and/or histological evidence of TB. Findings on clinical history and examination including APACHE II score at presentation, chest radiograph and/or CT and laboratory parameters were recorded. Need and duration of mechanical ventilation, days of hospital stay (DOHS) and survival were recorded. Various parameters were compared between survivors and non-survivors.
Mean duration of illness was 38 ± 25 days (range 10–90 days). Majority of patients (n=14, 78%) had underlying miliary TB. ARDS developed after initiation of anti-tuberculosis therapy (ATT) in 4 patients (22%) whereas the rest 14 patients presented with ARDS and were later diagnosed to have TB. Disseminated intravascular coagulation (DIC) was seen in 4 patients whereas 3 patients had multi-organ dysfunction (MODS). Invasive ventilation was required in 13 patients (81%). Mean duration of stay on ventilator was 9.6 ± 8.4 days. Mean DOHS was 14.7 ± 14.1 days. Survival to discharge was 50%. Survivors had lower mean APACHE II (13.8 versus 22.3, p=0.008) and higher mean Glasgow coma scale (GCS) score (15 versus 10.5, p=0.03) at presentation. Patients who developed ARDS after initiation of ATT had increased survival (100% versus 35.7%, p=0.023).CONCLUSIONS: ARDS secondary to PTB is associated with significant morbidity and mortality. Many patients may have MODS and DIC. Development of ARDS after initiation of ATT seems to be associated with better outcome. APACHE II score and GCS at presentation predict mortality.
Patients with ARDS secondary to PTB should be screened for DIC and MODS. APACHE II score is useful for prognosis in such patients.
A. Banga, None.