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Corticosteroids could improve 90 day mortality in TB patients
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Corticosteroids could reduce 90-day mortality rates in patients with tuberculosis who are in acute respiratory failure, according to researchers in South Korea.
“In South Korea, tuberculosis remains a major problem, although new cases have plateaued at approximately 100 cases per 100,000 individuals over the past decade,” Ji Young Yang, MD, of the department of internal medicine at Busan Paik Hospital, Inje University College of Medicine, and colleagues wrote. “Considering this unacceptably high mortality rate, adjuvant therapy along with anti-tuberculosis treatment can be considered for such patients. Corticosteroids represent an attractive option because they can suppress cytokine expression and are effective in managing the inflammatory complications of extrapulmonary tuberculosis.”
The researchers reviewed records for adult patients with pulmonary TB who were admitted to the ICU at Asan Medical Center, Seoul, from March 1989 to December 2014. Only patients with acute respiratory failure were included in the retrospective analysis (n = 124).
The mean age of patients was 62 years, and 63.7% were male. About 57% of the patients received corticosteroids as adjuvant therapy. The mean hospital stay was 38 days, the mean ICU stay was 20 days, and the mean duration of mechanical ventilation was 17 days. Of the total cohort, 76 patients had underlying disease, including chronic respiratory disease, cardiovascular disease or chronic liver disease.
Sixty-one patients died, yielding a 90-day mortality rate of 49.2%. Yang and colleagues reported the mortality rate was similar regardless of steroid use: 50% in the nonsteroid group and 48.6% in the steroid group. Adjuvant steroid use was not associated with the unadjusted mortality rate, they wrote (OR = 0.94; 95% CI, 0.46-1.92). However, when researchers compared the two groups using an adjusted inverse-probability-of-treatment-weighted method, they reported corticosteroid use was independently associated with a reduced 90-day mortality rate (OR = 0.47; 95% CI, 0.22-0.98).
“In conclusion, corticosteroids could reduce the 90-day mortality for patients with pulmonary tuberculosis who were admitted to the ICU because of acute respiratory failure and could be considered a viable adjuvant therapy for our study patients,” Yang and colleagues wrote. – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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