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Predictors of Development of Acute Respiratory Distress Syndrome in Miliary Tuberculosis FREE TO VIEW

Amit Banga, MD*; A. Mohan, MD; P. K. Saha, MBBS; S. K. Sharma, MD, PhD
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All India Institute of Medical Sciences, New Delhi, India


Chest. 2004;126(4_MeetingAbstracts):753S. doi:10.1378/chest.126.4_MeetingAbstracts.753S
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PURPOSE:  Acute respiratory distress syndrome (ARDS) develops rarely in patients with tuberculosis (TB). An overwhelming number of patients with ARDS secondary to TB are due to miliary TB (MTB). Literature on predictors of ARDS in MTB is sparse.

METHODS:  We reviewed case records of 136 patients with MTB admitted to our center over a 15-year period (1988-2002). Diagnosis of MTB was based on demonstration of classical miliary shadows on chest radiograph and/or CT chest with histopathological and/or micorobiological evidence of TB. Out of these, 22 cases developed ARDS (bilateral lung infiltrates with PaO2/FiO2 ratio <200 in absence of left atrial hypertension). Clinical profile and laboratory parameters at admission were compared between patients with MTB without ARDS (n=114) and MTB with ARDS (n=22).

RESULTS:  Patients with ARDS were likely to have a longer history of illness prior to diagnosis (days) (43 ± 20 vs 12 ± 16, p<0.001), present with fever (100% vs 86.8%, p=0.07), cough (90.9% vs 56.1%, p=0.002) and shortness of breath (90.9% vs 26.3%, p<0.001) and have lower serum potassium (mEq/L) (3.8 ± 0.5 vs 4.3 ± 0.7, p=0.004). Only independent predictors of development of ARDS in MTB (estimated by multivariate logistic regression analysis) were delay in diagnosis beyond 20 days {odds ratio (OR), 95% confidence interval (CI): 101.0, 9.6-1059.1; p<0.001} and shortness of breath (OR, 95% CI: 60.5 (5.6-654.9), p=0.001).

CONCLUSION:  A delay in diagnosis and presentation with shortness of breath are independent predictors of ARDS in MTB.

CLINICAL IMPLICATIONS:  Early diagnosis with quick institution of anti-tuberculosis therapy should be the goal in patients with MTB, as duration of illness beyond 20 days tends to markedly increase the risk of developing ARDS. All patients with MTB presenting with shortness of breath should be evaluated for presence of ARDS.

DISCLOSURE:  A. Banga, None.

Tuesday, October 26, 2004

12:30 PM- 2:00 PM




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