Validation of a severity-of-illness score in patients with tuberculosis requiring intensive care unit admission
| dc.contributor.author | Koegelenberg, Coenraad Frederik N. | en_ZA |
| dc.contributor.author | Balkema, Cecile A. | en_ZA |
| dc.contributor.author | Jooste, Ynishia | en_ZA |
| dc.contributor.author | Taljaard, Jantjie J. | en_ZA |
| dc.contributor.author | Irusen, Elvis M. | en_ZA |
| dc.date.accessioned | 2016-03-18T12:13:13Z | |
| dc.date.available | 2016-03-18T12:13:13Z | |
| dc.date.issued | 2015-05-27 | |
| dc.description | Please 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.description | The original publication is available at http://www.samj.org.za | en_ZA |
| dc.description.abstract | Background. 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.uri | http://www.samj.org.za/index.php/samj/article/view/9148 | en_ZA |
| dc.description.version | Publisher's version | en_ZA |
| dc.format.extent | 4 pages | en_ZA |
| dc.identifier.citation | 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.identifier.issn | 2078-5135 (online) | |
| dc.identifier.issn | 0256-9574 (print) | |
| dc.identifier.other | doi:10.7196/SAMJ.9148 | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/98885 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Health & Medical Publication Group | en_ZA |
| dc.rights.holder | South African Medical Journal | en_ZA |
| dc.subject | Tuberculosis -- Mortality | en_ZA |
| dc.subject | APACHE (Disease classification system) | en_ZA |
| dc.title | Validation of a severity-of-illness score in patients with tuberculosis requiring intensive care unit admission | en_ZA |
| dc.type | Article | en_ZA |