Predicting Mortality in Patients with Tuberculous Destroyed Lung Receiving Mechanical Ventilation.
- Author:
Won Young KIM
1
;
Mi Hyun KIM
;
Eun Jung JO
;
Jung Seop EOM
;
Jeongha MOK
;
Ki Uk KIM
;
Hye Kyung PARK
;
Min Ki LEE
;
Kwangha LEE
Author Information
- Publication Type:Validation Studies ; Original Article
- Keywords: Mechanical Ventilation; Mortality; Prognosis; Risk; Tuberculosis
- MeSH: Cohort Studies; Humans; Intensive Care Units; Korea; Logistic Models; Lung*; Mortality*; Multivariate Analysis; Natriuretic Peptide, Brain; Oxygen; Partial Pressure; Prognosis; Prospective Studies; Respiration, Artificial*; Respiratory Insufficiency; Retrospective Studies; ROC Curve; Tertiary Healthcare; Tuberculosis
- From:Tuberculosis and Respiratory Diseases 2018;81(3):247-255
- CountryRepublic of Korea
- Language:English
- Abstract: 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.
