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Validation of a severity-of-illness score in patients with tuberculosis requiring intensive care unit admission

dc.contributor.authorKoegelenberg, Coenraad Frederik N.en_ZA
dc.contributor.authorBalkema, Cecile A.en_ZA
dc.contributor.authorJooste, Ynishiaen_ZA
dc.contributor.authorTaljaard, Jantjie J.en_ZA
dc.contributor.authorIrusen, Elvis M.en_ZA
dc.date.accessioned2016-03-18T12:13:13Z
dc.date.available2016-03-18T12:13:13Z
dc.date.issued2015-05-27
dc.identifier.citationKoegelenberg, C. F. N., Balkema, C. A., Jooste, Y., Taljaard, J. J. & Irusen, E. M. 2015. Validation of a severity-of-illness score in patients with tuberculosis requiring intensive care unit admission. South African Medial Journal, 105(5):389-392, doi:10.7196/SAMJ.9148.en_ZA
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.9148
dc.identifier.urihttp://hdl.handle.net/10019.1/98885
dc.descriptionPlease cite as follows: Koegelenberg, C. F. N., Balkema, C. A., Jooste, Y., Taljaard, J. J. & Irusen, E. M. 2015. Validation of a severity-of-illness score in patients with tuberculosis requiring intensive care unit admission. South African Medial Journal, 105(5):389-392, doi:10.7196/SAMJ.9148.en_ZA
dc.descriptionThe original publication is available at http://www.samj.org.zaen_ZA
dc.description.abstractBackground. There is a paucity of data on the determinants of mortality due to tuberculosis (TB) in the intensive care unit (ICU). Objective. To develop a simple severity-of-illness score for use in patients with TB admitted to an ICU. Methods. A scoring system was generated by retrospectively identifying the four most significant and clinically unrelated predictors of mortality from an existing prospectively collected dataset (January 2012 - May 2013), and combining these with known predictors of poor outcome. Results. Of 83 patients admitted with TB, 38 (45.8%) died in the ICU. The four parameters identified from the retrospective analysis were: (i) HIV co-infection with a CD4 cell count <200/μL; (ii) a raised creatinine level: (iii) a chest radiograph showing diffuse parenchymal infiltrates/miliary pattern; and (iv) absence of TB treatment on admission. These were combined with septic shock and a low arterial partial pressure of oxygen/fractional inspired oxygen (P:F) ratio to generate a six-point severity-of-illness score (one point for each parameter). The scores for survivors were significantly lower than those for non-survivors (mean (standard deviation) 2.27 (1.47) v. 3.58 (1.08); p<0.01). A score of ≥2 was associated with significantly higher mortality than a score of <2 (7.1% v. 46.4%; odds ratio (OR) 15.03; 95% confidence interval (CI) 1.86 - 121.32; p<0.01), whereas a score of ≥3 was associated with a significantly higher mortality than a score of <3 (64.6% v. 20.0%; OR 7.29; 95% CI 2.64 - 20.18; p<0.01). Conclusion. The proposed scoring system identified patients at increased risk of dying from TB in the ICU. Further prospective studies are indicated to validate its use.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/9148en_ZA
dc.format.extent4 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publication Groupen_ZA
dc.subjectTuberculosis -- Mortalityen_ZA
dc.subjectAPACHE (Disease classification system)en_ZA
dc.titleValidation of a severity-of-illness score in patients with tuberculosis requiring intensive care unit admissionen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's versionen_ZA
dc.rights.holderSouth African Medical Journalen_ZA


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