Effectiveness of systemic corticosteroids in hospitalized pulmonary tuberculosis with acute respiratory failure: a retrospective cohort study
Abstract
OBJECTIVE
To evaluate the effectiveness of systemic corticosteroids in hospitalised patients with pulmonary tuberculosis (TB) with acute respiratory failure (ARF).
METHODS
A retrospective cohort study was conducted by reviewing all medical records of hospitalized patients with pulmonary TB with ARF from January 2014 through December 2016 in Khon Kaen Hospital, Thailand. The exposure of our interest was the systemic corticosteroids regardless of doses and durations. Our primary outcome was 90-day all-cause mortality after admission and our secondary outcomes were cardiac arrest, shock, duration of hospital stay and duration of mechanical ventilator use.
RESULTS
There were 481 pulmonary TB with ARF patients during the study period; 167 were treated with systemic corticosteroids and 314 were not. We found that 90-day all-cause mortality was not significantly different between the two groups (adjusted hazard ratio, 0.80; 95% confidence interval (CI), 0.62 to 1.03). For secondary outcome, we found that cardiac arrest (relative risk (RR), 0.99; 95% CI, 0.84 to 1.17), shock (RR, 1.15; 95% CI, 0.99 to 1.33) and duration of hospital stay (mean difference, 2.41; 95% CI, -0.14 to 4.96) were not significantly different between the two groups. However, the systemic corticosteroids were associated with significantly increased duration of mechanical ventilator use (mean difference, 2.42; 95% CI, 0.48 to 4.36).
CONCLUSION
The 90-day all-cause mortality was not significantly different between with and without systemic corticosteroids in patients with pulmonary TB with ARF.
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