Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure
Abstract:OBJECTIVES: To determine predictive factors for mortality among pulmonary tuberculosis (PTB) patients without human immunodeficiency virus (HIV) infection and in need of mechanical ventilation (TBMV).
METHODS: From July 2004 to December 2005, 612 respiratory failure patients requiring mechanical ventilation were admitted to the intensive care unit (ICU) of Chang Gung Memorial Hospital, Taipei, Taiwan. Of these, 59 non-HIV-infected patients had active PTB as the primary cause. Mortality rates were measured in TBMV patients and predictors were investigated. Incidence of treatment delay for nosocomial pneumonia was compared between survivors and fatalities.
RESULTS: Of the 59 patients with TBMV, 40 (67.8%) died in the ICU. Multi-organ failure syndrome (OR 8.59, 95%CI 1.85–101.27) and nosocomial pneumonia (OR 5.77, 95%CI 1.33–44.36) were independently associated with in-hospital mortality. Treatment delay >24 h for nosocomial pneumonia was significantly more frequent among fatalities than among survivors (19/26, 73.1% vs. 0/3, 0%; P = 0.033).
CONCLUSION: Nosocomial pneumonia in TB patients with respiratory failure is associated with a poor prognosis; this appears to be further aggravated by delays in appropriate treatment. Measures to prevent nosocomial pneumonia should be carefully instituted and treatment for nosocomial pneumonia should be started promptly among such patients.
Document Type: Regular Paper
Affiliations: 1: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan 2: Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan; and Department of Thoracic Medicine, St. Paul's Hospital, Taoyuan, Taiwan
Publication date: March 1, 2009
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.
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