A severity-of-illness score in patients with tuberculosis requiring intensive care
| dc.contributor.author | Lalla, U. | en_ZA |
| dc.contributor.author | Irusen, E. M. | en_ZA |
| dc.contributor.author | Allwood, B. W. | en_ZA |
| dc.contributor.author | Taljaard, J. J. | en_ZA |
| dc.contributor.author | Koegelenberg, C. F. N. | en_ZA |
| dc.date.accessioned | 2021-07-15T06:13:11Z | |
| dc.date.available | 2021-07-15T06:13:11Z | |
| dc.date.issued | 2021-03-02 | |
| dc.description | CITATION: Lalla, U. et al. 2021. A severity-of-illness score in patients with tuberculosis requiring intensive care. South African Medical Journal, 111(3):245-249, doi:10.7196/SAMJ.2021.v111i3.14609. | |
| dc.description | The original publication is available at http://www.samj.org.za | |
| dc.description.abstract | Background. We previously retrospectively validated a 6-point severity-of-illness score aimed at identifying patients at risk of dying of tuberculosis (TB) in the intensive care unit (ICU). Parameters included septic shock, HIV infection with a CD4 count <200 cells/µL, renal dysfunction, a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (P/F) <200 mmHg, a chest radiograph demonstrating diffuse parenchymal infiltrates, and no TB treatment on admission. Objectives. To prospectively validate the severity-of-illness scoring system in patients with TB requiring intensive care, and to refine and simplify the score in order to expand its clinical utility. Methods. We performed a prospective observational study with a planned post hoc retrospective analysis, enrolling all adult patients with confirmed TB admitted to the medical ICU of a tertiary hospital in Cape Town, South Africa, from 1 February 2015 to 31 July 2018. The admission data of all adult patients with TB requiring admission to the ICU were used to calculate the 6-point severity-of-illness score and a refined 4-point score (based on the planned post hoc analysis). Descriptive statistics and χ2 or Fisher’s exact tests (where indicated) were performed on dichotomous categorical variables, and t-tests on continuous data. Patients were categorised as hospital survivors or non-survivors. Results. Forty-one of 78 patients (52.6%) died. The 6-point scores of non-survivors were higher than those of survivors (mean (standard deviation (SD)) 3.5 (1.3) v. 2.7 (1.2); p=0.01). A score ≥3 v. <3 was associated with increased mortality (64.0% v. 32.1%; odds ratio (OR) 3.75; 95% confidence interval (CI) 1.25 - 10.01; p=0.01). Post hoc, a P/F ratio <200 mmHg and no TB treatment on admission failed to predict mortality, whereas any immunosuppression did. A revised 4-point score (septic shock, any immunosuppression, acute kidney injury and lack of lobar consolidation) demonstrated higher scores in non-survivors than survivors (mean (SD) 2.8 (1.1) v. 1.6 (1.1); p<0.001). A score ≥3 v. ≤2 was associated with increased mortality (78.4% v. 29.3%; OR 8.76; 95% CI 3.12 - 24.59; p<0.001). Conclusions. The 6-point severity-of-illness score identified patients at increased risk of death. We were able to derive and retrospectively validate a simplified 4-point score with superior predictive power. | en_ZA |
| dc.description.uri | http://www.samj.org.za/index.php/samj/article/view/13214 | |
| dc.description.version | Publisher's version | |
| dc.format.extent | 5 pages | en_ZA |
| dc.identifier.citation | Lalla, U. et al. 2021. A severity-of-illness score in patients with tuberculosis requiring intensive care. South African Medical Journal, 111(3):245-249, doi:10.7196/SAMJ.2021.v111i3.14609. | |
| dc.identifier.issn | 2078-5135 (online) | |
| dc.identifier.issn | 0256-9574 (print) | |
| dc.identifier.other | doi:10.7196/SAMJ.2021.v111i3.14609 | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/110726 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Health & Medical Publishing Group | en_ZA |
| dc.rights.holder | Authors retain copyright | en_ZA |
| dc.subject | Tuberculosis | en_ZA |
| dc.subject | Intensive care units | en_ZA |
| dc.subject | Severity-of-illness -- Scoring system | en_ZA |
| dc.subject | Patients -- Classification | en_ZA |
| dc.subject | Hospital care | en_ZA |
| dc.title | A severity-of-illness score in patients with tuberculosis requiring intensive care | en_ZA |
| dc.type | Article | en_ZA |