Kim Won Young, Kim Mi Hyun, Jo Eun Jung, Eom Jung Seop, Mok Jeongha, Kim Ki Uk, Park Hye Kyung, Lee Min Ki, Lee Kwangha
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
Tuberc Respir Dis (Seoul). 2018 Jul;81(3):247-255. doi: 10.4046/trd.2017.0126. Epub 2018 Jun 19.
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.
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.
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.
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.
继发于结核毁损肺（TDL）的急性呼吸衰竭患者预后较差。本回顾性研究的目的是为需要机械通气的TDL患者建立一个死亡率预测模型。
回顾了韩国一家大学附属医院连续收治的接受机械通气的TDL患者的数据。采用二元逻辑回归来确定预测重症监护病房（ICU）死亡率的因素。根据β系数值为变量赋值，计算出机械通气时的TDL（TDL-Vent）评分。
回顾了125例患者的数据。共有36例（29%）患者在ICU住院期间死亡。基于多因素分析，TDL-Vent评分纳入了以下因素：年龄≥65岁、使用血管活性药物以及动脉血氧分压/吸入氧分数比<180。在第二个回归模型中，通过加入脑钠肽计算出一个修正评分。对于TDL-Vent评分为0至3分的患者，60天死亡率分别为11%、27%、30%和77%（p<0.001）。对于修正后的TDL-Vent评分为0至≥3分的患者，60天死亡率分别为0%、21%、33%和57%（p=0.001）。对于TDL-Vent评分和修正后的TDL-Vent评分，受试者工作特征曲线下面积均大于其他疾病严重程度评分。
TDL-Vent模型可识别机械通气的TDL患者中具有高死亡风险的患者。目前有必要在更大的队列中进行前瞻性验证研究。
