PT - JOURNAL ARTICLE AU - Coenraad Koegelenberg AU - Cecile Balkema AU - Ynishia Jooste AU - Jantjie Taljaard AU - Elvis Irusen TI - A severity-of-illness score for tuberculosis in the intensive care unit DP - 2014 Sep 01 TA - European Respiratory Journal PG - P2651 VI - 44 IP - Suppl 58 4099 - http://erj.ersjournals.com/content/44/Suppl_58/P2651.short 4100 - http://erj.ersjournals.com/content/44/Suppl_58/P2651.full SO - Eur Respir J2014 Sep 01; 44 AB - Background: There is a paucity of data on the determinants of mortality of tuberculosis (TB) in the intensive care unit (ICU).The aim of this study was to develop a simple severity-of-illness score for the use in patients with TB necessitating ICU admission.Methods: All patients admitted to the ICU with TB from January 2012 until May 2013 were prospectively enrolled in order to identify potential parameters of poor outcome. Disease severity, co-morbid diagnoses, clinical features, radiological and laboratory investigations and outcomes were recorded. In addition, we performed an extensive literature review in order to devise a simple scoring system. Results: 83 patients (44 HIV-positive) were admitted with pulmonary (n=69) and/or extrapulmonary (n=37) tuberculosis. 39 (44.2%) patients died in the ICU. A CD4 <200 in HIV-co-infected patients (p=0.04), the absence of lobar consolidation (p=0.02) and renal failure (p=0.02) were associated with mortality. The following parameters (one point each) were subsequently retrospectively applied to the study population's admission data: (1) HIV with CD4<200, (2) creatinine >140 µmol/L (male) or >120 µmol/L (female), (3) diffuse parenchymal infiltrates / milliary pattern on x-ray, (4) a P:F ratio <200, (5) no TB treatment on admission and (6) septic shock. Survivors' scores were significantly lower than non-survivors (2.31 +/- 1.53 vs. 3.37+/- 1.05; p<0.01). Moreover, a score of ≥3 was associated with a significantly higher mortality compared to a score of <3 (62.0% vs. 21.2%; OR 6.06; 95% CI, 2.20-16.66; p<0.01).Conclusion: Our scoring system can potentially identify patients at higher risk of mortality. Further prospective studies are indicated to validate its use.