Retrospective Analysis Of 385 Cased Diagnosed Adult Acute Miliary Tuberculosis Complicated With Ards, Chongqing, China

Objective: (1)Analyze the clinic diagnostic of 31 patients developed to ARDS in 385 patients with Miliary Tuberculosis;(2)Explore the predictors of ARDS in MTB;Methods: Retrospectively analyze 385 patients admitted with a diagnosis of ARDS in 4 hospitals over the previous 4 years. The patients were divided into ARDS group and non-ARDS group, survival group and death group, survival ARDS group and death ARDS group. Analyze the corresponding criticality of predictors compared death group with survival group, the sensitivity, the specificity and positive likelihood ratio.Results: There were 13879 admissions in respiratory departments of the four hospitals. 385 patients were proven to have military tuberculosis. Of the 385 patients, 31 patients developed ARDS. The mean duration of insive ventilation was 6.51±3.04 days, and the mean duration of non-insive ventilation was 8.24±4.12 days.28-day mortality was 32.25%. There were statistical differences in terms of past history of diabetes, duration from symptom to anti-tuberculosis, AST, ALT, ESR, D-dimer , Hb, albumin. For the survivors and non-survivors, besides mentioned predictors, there was statical difference in terms of history of diabetes besides. All the following predictors were independent risk factors for 28-day mortality: the interval between from admission to anti-tuberculosis therapy(OR=5.744,95%CI 1.553-21.242, P=0.017),AST(OR=4.034, 95%CI 2.200-8.341, P=0.002), ALT(OR=3.029, 95%CI 2.764-7.389, P=0.001), serum albumin(OR=15.896, 95%CI 3.975-63.566, P=0.001), hemoglobin(OR=14.824, 95%CI=3.713-59.179, P=0.001), D-dimer ( D-dimer ) (OR=3.167, 95%CI=0.896-11.187,P=0.042), history of mellitus diabetes(OR=5.421, 95%CI 1.471-14.587,P=0.005). The helpful range of mentioned predictors for diagnose were: alanine aminotransferase:> 70U / L, aspartate aminotransferase:> 94U / L,D-dimer:> 1.6mg / L, hemoglobin: <90 g / L, albumin: <25 g / L .Conclusion : The incidence of of the MTB patients with ARDS isn't low, mortality and misdiagnosis rate of which are at a high level. Early diagnosis, early treatment is the key point.