Effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure: a cohort study

Background:  Tuberculosis (TB) remains an important and evolving health problem worldwide. Acute respiratory failure, the most severe form of pulmonary tuberculosis, is associated with a high mortality rate. Adjunctive corticosteroid therapy has been reported as an effective treatment in extrapulmonary TB. The aim of this study was to investigate the effect of adjunctive corticosteroid therapy on outcomes in pulmonary tuberculosis patients with acute respiratory failure. Methods: This retrospective cohort study enrolled newly diagnosed pulmonary tuberculosis patients with acute respiratory failure who were admitted to Siriraj Hospital (Bangkok, Thailand) during January 2011 to December 2013. Patients that received corticosteroid as an adjunctive treatment for pulmonary TB were assigned to the steroid group. The control group consisted of patients that did not receive corticosteroid. Collected data included age, gender, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, sequential organ failure assessment (SOFA) scores, vital signs, PaO2/FiO2 ratio, chest X-ray abnormality pattern, and TB treatment strategies, including antituberculosis agents and adjunct corticosteroid treatment. The primary outcome was hospital mortality rate. The secondary outcomes were hospital length of stay and duration of mechanical ventilation. Results: Thirty-eight patients were included. There were 18 patients in the steroid group and 20 in the control group. No significant difference was observed between groups for age, gender, BMI, APACHE II score, vital signs, or PaO2/FiO2 ratio. Patients in the steroid group had a significantly higher mean SOFA score than controls (5.7±4.5 vs. 3.3±2.6, respectively; p=0.046). Almost all patients in this study (97.1%) had positive culture for M. tuberculosis from sputum. The mean corticosteroid dose was equivalent to hydrocortisone 329.7±146.0 mg/day. Patients in the steroid group had higher hospital mortality than control group patients, but the difference did not achieve statistical significance (66.7% vs. 45.0%, respectively; p=0.21). Adjunctive corticosteroid therapy did not significantly reduce hospital length of stay or duration of mechanical ventilation when compared between the steroid and control groups (12.0±13.3 vs. 14.6±19.3 days, respectively; p=0.636 and 7.2±10.6 vs. 8.0±8.3 days, respectively; p=0.801). Conclusion: Adjunctive corticosteroid therapy had no significant positive effect on outcomes in pulmonary tuberculosis patients with acute respiratory failure.