Albumin plays an important role in regulating plasma osmolality. Hypoproteinemia accelerates fluid exudation, promotes alveolar edema, and contributes to ventilation-perfusion imbalance. Also, in infected mycobacterium tuberculosis, inflammatory cells accumulate in the alveolar spaces, releasing granular enzymes and oxidants which participate in local inflammation and overlapping reactions and damaging the alveolar basement which allows increase in cellular permeability that aggravates oxygen dysfunction and consequently causes ARDS [16, 17] . If the process continues, cytokines activate an inflammatory cascade reaction and lead to other organs dysfunction, resulting in increases in AST and ALT. The changes in AST, ALT, and serum albumin were significantly different between survivor and non-survivor groups. The results showed that AST, ALT, and serum albumin could be independent predictors of ARDS development in miliary TB.