TY - JOUR T1 - Prospective validation of a proposed severity-of-illness score in patients with tuberculosis requiring intensive care unit admission JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2019.PA555 VL - 54 IS - suppl 63 SP - PA555 AU - Coenraad Frederik Nicolaas Koegelenberg AU - Usha Lalla AU - Jantjie J Taljaard AU - Brian W Allwood AU - Elvis M Irusen Y1 - 2019/09/28 UR - http://erj.ersjournals.com/content/54/suppl_63/PA555.abstract N2 - We previously retrospectively validated a 6-point severity-of-illness score aimed at identifying patients at risk of dying of TB in ICU. The parameters used were septic shock, HIV with a CD4<200/mm3, impaired renal function, PaO2:FiO2<200, diffuse parenchymal infiltrates and no concomitant TB treatment on admission. The aim of the present study was to prospectively validate and potentially refine the scoring system.All patients admitted to ICU with confirmed TB over a 2-year period were included. A planned post-hoc analysis was performed to assess the significance of various parameters and potentially derive a simplified score with an equally/higher predictive power.78 patients (40 males, 36.1+/-14.4 y) were admitted with TB (pulm, n=76; extrapulm, n=2). 41 (52.6%) died. The 6-point scores of non-survivors were higher (3.5+/-1.3 vs 2.7+/-1.2; p=0.01) than survivors. A score ≥3 was associated with higher mortality compared to <3 (63.3% vs 34.5%; OR 3.3; 95%CI, 1.3-8.7; p=0.02). Post-hoc, a PF<200 failed to predict mortality, whereas other causes of immunosuppression did. A revised 5-point score (septic shock, any immune suppressed state, impaired renal function, diffuse parenchymal infiltrates and no concomitant TB treatment) was retrospectively applied. The 5-point scores of non-survivors were higher than survivors (3.3+/-1.2 vs 2.7+/-1.1; p<0.001). A score ≥3 was associated with higher mortality compared to <3 (31.0% vs 65.3%; OR 5.8; 95%CI, 2.2-15.8; p<0.001).Although the 6-point score identified patients at higher risk of dying, we were able to derive and retrospectively validate a simplified 5-point score with superior predictive power.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA555.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -