Do Corticosteroids Reduce the Death Rate in Tuberculosis Patients with Acute Respiratory Failure?

Tuberculosis has remained stubbornly present worldwide, with 9 million new cases and 1.5 million deaths in 2013 alone. South Korea, where the disease affects approximately one out of 1,000 people, is no exception. While the mortality rate for tuberculosis patients in South Korea ranges anywhere from 5% to 10%, this rate soars when patients have tuberculosis along with acute respiratory failure—to up to 60% to 70%. Acute respiratory failure is characterized by severe shortness of breath at rest, abnormally rapid breathing, an inability to get enough oxygen from the lungs into the blood, and a buildup of carbon dioxide in the blood.

In a recent study, a group of researchers at Inje College of Medicine and Asan Medical Center in South Korea decided to investigate whether or not corticosteroids are an effective addition to the treatment regimen for patients who have both tuberculosis and acute respiratory failure. Corticosteroids are known to counteract inflammation, and they already had been shown to cut the death rate or treatment-failure rate in patients with tuberculosis or severe pneumonia. The subjects, 124 in all, were chosen from among 1,870 adults with confirmed, probable, or possible tuberculosis who were admitted to the ICU over a 25-year period; their mean age was 62, and most were men. Seventy-six of the 124 patients had underlying diseases such as chronic respiratory illnesses, cardiovascular disease, chronic liver disease, and others. Out of these 124 subjects, 70 (56.5%) had been given corticosteroids as an accompaniment to their treatment for tuberculosis.

Over the course of 90 days after ICU admission, just under half of the patients died. The mortality rate looked very similar in both the corticosteroid group (48.6%) and the noncorticosteroid group (50%). However, after adjusting for inverse probability of treatment weighted (IPTW), it became clear that patients who received corticosteroids were significantly less likely to die in the next 90 days. Thus, the researchers concluded that corticosteroids may be a good addition to a treatment regimen for tuberculosis accompanied by acute respiratory failure.

The study authors noted a few limitations. One is that their subject pool was small and taken from a single health center. Also, they were chosen from a very long time period, with subjects in 1989 being measured against subjects in 2014. During this time, ICU protocols changed, which potentially could have affected the subjects’ responses; the authors tried to account for this. Also, the subjects were offered corticosteroids an average of 3.2 days after ICU admission; because they lived for that long before starting the corticosteroids, they may have had an inherent advantage over patients who were admitted to the ICU but died quickly. The authors also noted that because the rate of HIV infection is low in South Korea, they cannot say whether concurrent HIV infection might affect the efficacy of corticosteroids or other treatments. Similarly, they don’t know whether patients with drug-resistant tuberculosis would respond to corticosteroids.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.