Clinical outcomes and prognostic factors in patients with tuberculous destroyed lung

OBJECTIVE: To characterise the prognosis and identify factors contributing to mortality in patients with tuberculous destroyed lung (TDL). DESIGN: Following a retrospective review of clinical data and radiographic findings, 169 patients with TDL were enrolled in this study. All patients were graded on a 4-point scale (field score 1-4) based on the extent of destroyed lung parenchyma on chest radiography. RESULTS: The mean patient age was 64 years (range 33 90); 103 (61%) were male. The median number of hospitalisations was 1 (range 0-11) during follow-up, with a mean duration of 31 months (range 0-172). Pneumonia developed in 96 patients (57%), while 50 patients (30%) developed acute respiratory failure requiring mechanical ventilation, 37 (22%) haemoptysis, 24 (14%) spontaneous pneumothorax and 22 (13%) reactivation of tuberculosis. Overall mortality was 28% (47/169), with a median survival of 39 months (range 0-176) after diagnosis. TDL-related mortality was 19% (32/169), and a field score 3 was the only independent predictor of shorter survival based on a Cox proportional hazards model (HR 3.520, 95% CI 1.51-8.20, P = 0.004). CONCLUSION: TDL has a poor prognosis, particularly in patients with more extensive lung destruction.