A proposed scoring system for predicting mortality in melioidosis

Allen C. Cheng, Susan P. Jacups, Nicholas M Anstey, Bart J. Curries

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14 Citations (Scopus)

Abstract

Melioidosis, due to infection with the environmental organism Burkholderia pseudomallei, continues to beassociated with high mortality despite improvements in antibiotic therapy. Using simple clinical findings and baseline laboratory tests available at the time of admission, we attempted to define those patients with acute melioidosis who were at higher risk of death. Using data, collected prospectively from the period October 1989 to June 2002, from patients with acute culture-confirmed melioidosis presenting at the Royal Darwin Hospital, Darwin, Australia, a number of variables were selected that were easily available at the time of admission and reflected organ dysfunction. Mortality was predicted in univariate logistic and multivariate models by the presence of pneumonia, age at diagnosis, serum urea, serum bilirubin, lymphocyte count, and serum bicarbonate. A score was assigned from 0 to 2, based on the degree of abnormality. A melioidosis score was formed from the sum of these scores, with a maximum score of 11. A score of ≤ 3 (n = 140) was associated with a mortality of 8.6%, whereas a score of ≥ 4 (n = 112) was associated with a mortality of 44.6%. Although this scoring system requires external validation, it may help identify a suitable target group of patients for intensive intervention such as early admission to an intensive care unit, the early use of meropenem, and goal-directed resuscitation therapies.

Original languageEnglish
Pages (from-to)577-581
Number of pages5
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Volume97
Issue number5
DOIs
Publication statusPublished - Sep 2003
Externally publishedYes

Keywords

  • Australia
  • Burkholderia pseudomallei
  • Melioidosis
  • Mortality
  • Multiple organ failure
  • Prognosis
  • Severity of illness index

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