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Effects of Corticosteroids on Critically Ill Pulmonary Tuberculosis Patients with Acute Respiratory Failure: A Propensity Analysis of Mortality

  1. Kyung-Wook Jo3
  1. 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
  2. 2Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
  3. 3Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
  1. Corresponding author: Kyung-Wook Jo, Division of Pulmonary & Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, 138-736, Seoul, South Korea. Phone: 82-2-3010-5783; Fax: 82-2-3010-6968, E-mail: heathcliff6800{at}hanmail.net
  1. Ji Young Yang and Minkyu Han contributed equally to this work.

Abstract

Backgrounds. We investigated the effects of corticosteroids on the 90-day mortality outcomes in patients with pulmonary tuberculosis (PTB) who were admitted to the intensive care unit (ICU) because of acute respiratory failure (ARF).

Methods. The medical records of 124 patients who had PTB with ARF and were admitted to the ICU at our tertiary referral center in South Korea between March 1989 and December 2014 were retrospectively analyzed. The 90-day mortality rate in this population was analyzed after adjustments with the inverse-probability-of-treatment-weighted (IPTW) method.

Results. The mean patient age was 62 years, and the 90-day mortality rate was 49.2% (61/124). Adjuvant steroids were used in 70 (56.5%) patients. The 90-day mortality rate was similar irrespective of corticosteroid use (48.6%, steroid group; 50.0%, non-steroid group). The use of adjuvant steroids was not associated with the unadjusted 90-day mortality (odds ratio, 0.94; 95% CI, 0.46–1.92; p=0.875). In a comparison using an adjusted IPTW approach of the 90-day mortality between the two groups, we found that corticosteroid use was independently associated with reduced 90-day mortality (odds ratio, 0.47; 95% CI, 0.22–0.98; p=0.049).

Conclusion. The study results showed that corticosteroids could reduce the 90-day mortality rate in critically ill PTB patients with ARF.

UNCORRECTED PROOF

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