The Korean Journal of Medicine

  • 제81권4호
  • /
  • Pages.458-463
  • /
  • 2011
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

결핵에 의한 급성호흡곤란증후군의 사망률 및 예후 예측인자

Mortality and Prognostic Factors in Acute Respiratory Distress Syndrome due to Tuberculosis

  • 김태옥 (전남대학교 의과대학 내과학교실) ;
  • 강현욱 (전남대학교 의과대학 내과학교실) ;
  • 지수영 (전남대학교 의과대학 내과학교실) ;
  • 반희정 (전남대학교 의과대학 내과학교실) ;
  • 오인재 (전남대학교 의과대학 내과학교실) ;
  • 김규식 (전남대학교 의과대학 내과학교실) ;
  • 김유일 (전남대학교 의과대학 내과학교실) ;
  • 임성철 (전남대학교 의과대학 내과학교실) ;
  • 김영철 (전남대학교 의과대학 내과학교실) ;
  • 권용수 (전남대학교 의과대학 내과학교실)
  • Kim, Tae-Ok (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kang, Hyun-Wook (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Chi, Su-Young (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Ban, Hee-Jung (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Oh, In-Jae (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Kyu-Sik (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Yu-Il (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Sung-Chul (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Young-Chul (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kwon, Yong-Soo (Department of Internal Medicine, Chonnam National University Medical School)
  • 발행 : 2011.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 본 연구는 결핵에 의한 급성호흡곤란증후군의 사망률 및 사망 예측인자를 알아보기 위해 시행하였다. 방법: 전남대학교병원에서 2005년 1월부터 2010년 12월까지 결핵에 의한 급성호흡곤란증후군으로 치료받은 19명의 환자들을 대상으로 인구학적, 임상적, 영상의학적, 검사실 정보를 후향적으로 조사하였다. 결과: 모든 환자들의 연령의 중앙값은 71세이고 호흡곤란(90%)이 가장 흔한 증상이었다. 사망률은 73%였다. APACHE III 점수와 psi 점수의 중앙값은 각각 81.9 (IQR 59.0-92.0)와 111.0 (IQR 77.0-131.0)이었다. PSI 점수는 사망 군에서 높았다(55.0 vs. 122.0, p = 0.016). 사망 군에서 입원 전 결핵치료를 시작한 경우가 적었고(13% vs. 75%, p = 0.037) 입원부터 결핵치료 시작까지 시간이 짧았다(3 vs. 0 days, p = 0.049). 가장 흔한 사망원인은 교정되지 않는 쇼크(53%)였다. 결론: 결핵에 의한 급성호흡곤란증후군의 사망률은 높았고 결핵치료의 지연이 사망과 연관이 있을 것으로 추정한다.

Background/Aims: Acute respiratory distress syndrome (ARDS) due to tuberculosis (TB) is a rare disease, but its mortality is believed to be high. The aim of this study was to evaluate the mortality rate and prognostic factors of ARDS. Methods: We retrospectively reviewed the demographic, clinical, radiologic, and laboratory data of 19 patients with ARDS due to active pulmonary TB at Chonnam National University Hospital between January 2000 and December 2010. Results: The median age of patients was 71.1 (interquartile range [IQR] 51-74) years. None had a history of TB treatment. The most common symptoms were dyspnea (90%), fever (68%), and cough (53%). The overall in-hospital mortality was 73%. The median acute physiologic assessment and chronic health evaluation (APACHE) III score and pneumonia severity index (PSI) were 81.9 (IQR 59.0-92.0) and 111.0 (IQR 77.0-131.0), respectively. The PSI was significantly higher in non-survivors than in survivors (55.0 vs. 122.0; p = 0.016). The rate of TB treatment before admission was significantly higher in survivors than in non-survivors (75% vs. 13%; p = 0.037). The time from admission to treatment initiation was significantly longer in non-survivors than in survivors (3 vs. 0 days; p = 0.049). The median duration of mechanical ventilation was 11 days (IQR 5-16 days). The most common cause of death was a refractory shock (53%). Conclusions: The overall mortality rate of ARDS due to pulmonary TB was high. A high PSI score and delay of TB treatment may be risk factors for a poor outcome of ARDS due to pulmonary TB.

키워드

참고문헌

  1. Piqueras AR, Marruecos L, Artigas A, Rodriguez C. Miliary tuberculosis and adult respiratory distress syndrome. Intensive Care Med 1987;13:175-182.
  2. Penner C, Roberts D, Kunimoto D, Manfreda J, Long R. Tuberculosis as a primary cause of respiratory failure requiring mechanical ventilation. Am J Respir Crit Care Med 1995;151(3 Pt 1):867-872. https://doi.org/10.1164/ajrccm.151.3.7881684
  3. Kim JY, Park YB, Kim YS, et al. Miliary tuberculosis and acute respiratory distress syndrome. Int J Tuberc Lung Dis 2003;7:359-364.
  4. Agarwal R, Gupta D, Aggarwal AN, Behera D, Jindal SK. Experience with ARDS caused by tuberculosis in a respiratory intensive care unit. Intensive Care Med 2005;31:1284-1287. https://doi.org/10.1007/s00134-005-2721-2
  5. Sharma SK, Mohan A, Banga A, Saha PK, Guntupalli KK. Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis. Int J Tuberc Lung Dis 2006;10:429-435.
  6. Zahar JR, Azoulay E, Klement E, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive Care Med 2001;27:513-520. https://doi.org/10.1007/s001340000849
  7. Kee SJ, Kim SM, Kim SH, et al. Multiplex PCR assay for identification of mycobacterial species isolated from liquid cultures. Chonnam Med J 2009;45:19-26, http://dx.doi.org/10.4068/cmj.2009.45.1.19.
  8. Bernard GR, Artigas A, Brigham KL, et al. The American- European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149(3 Pt 1):818-824. https://doi.org/10.1164/ajrccm.149.3.7509706
  9. The Korean Academy of Tuberculosis and Respiratory Disease. Guideline for the management of tuberculosis: The Korean Academy of Tuberculosis and Respiratory Disease; 2005.
  10. Phua J, Badia JR, Adhikari NK, et al. Has mortality from acute respiratory distress syndrome decreased over time? A systematic review. Am J Respir Crit Care Med 2009;179:220-227. https://doi.org/10.1164/rccm.200805-722OC
  11. Pablos-Mendez A, Sterling TR, Frieden TR. The relationship between delayed or incomplete treatment and all-cause mortality in patients with tuberculosis. JAMA 1996;276:1223-1228. https://doi.org/10.1001/jama.1996.03540150025026
  12. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-250. https://doi.org/10.1056/NEJM199701233360402
  13. Ryu YJ, Koh WJ, Kang EH, et al. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology 2007;12:406-411. https://doi.org/10.1111/j.1440-1843.2006.01007.x