Scoring system for prediction of severity and mortality in pulmonary melioidosis
Keywords:
Scoring system, mortality, pneumonia, Burkholderia pseudomalleiAbstract
Objective : To establish the scoring system for predicting mortality in pulmonary melioidosis.
Methods : This is a retrospective cohort study in patients who diagnosed as pulmonary melioidosis. The sample were collected at Khon Kaen Hospital from January 1st, 2017 to December 31st, 2018, as a training set. We use the clinical characteristics of severe pneumonia of this set to create the scoring system. We tested the validity of our system for predicting mortality in patients from January 1st, 2019 to June 30th, 2019, as a validation set.
Results : The scoring system was created from the training set of 245 patients. We found 9 factors associating to severity. These factors are mental status, rate of disseminated form, respiratory rate, heart rate, systolic blood pressure, absolute lymphocyte count, blood urea nitrogen, arterial pH, and PaO2/FiO2 with the adjusted odds ratio of 17.16, 5.01, 1.09, 1.02, 0.99, 0.99, 0.99, 0.00 and 0.99, respectively. The scoring system was then used on the validation set of 42 patients. The result showed
that the system can predict mortality correctly in high risk group and in very high-risk group that have the mortality equal to 66.7% and 87.5%, respectively. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and Youden index in high risk group are 21.1, 91.3, 2.421, 0.865, and 0.325, respectively, while in very high-risk group are 36.8, 95.7, 8.474, 0.66, and 0.325, respectively.
Conclusions : The scoring system can predict the mortality correctly. This may help physicians plan better treatment, and reduce mortality rate.
References
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Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, Rolim DB, Bertherat E, Day NP, Peacock SJ, Hay SI. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nature microbiology. 2016 Jan 11 ; 1 : 150-158.
Vuddhakul V, Tharavichitkul P, Na-Ngam N, Jitsurong S, Kunthawa B, Noimay P, Binla A,Thamlikitkul V. Epidemiology of Burkholderia pseudomallei in Thailand. The American journal of tropical medicine and hygiene. 1999 Mar 1 ; 60(3) : 458-461.
Reechaipichitkul W, Lulitanond V, Tantiwong P, Saelee R, Pisprasert V. Etiologies and treatment outcomes in patients hospitalized with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian journal of tropical medicine and public health. 2005 Jan 1 ; 36(1) : 156.
Chaowagul W, White NJ, Dance DA, Wattanagoon Y, Naigowit P, Davis TM, Looareesuwan S,Pitakwatchara N. Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand. Journal of Infectious Diseases. 1989 May 1 ; 159(5) : 890-899.
Kanoksil M, Jatapai A, Peacock SJ, Limmathurotsakul D. Epidemiology, microbiology and mortality associated with community-acquired bacteremia in northeast Thailand: a multicenter surveillance study. PloS one. 2013 Jan 18 ; 8(1) : e54714.
Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, Chaowagul W, Day NP, Peacock SJ. Increasing incidence of human melioidosis in Northeast Thailand. The American journal of tropical medicine and hygiene. 2010 Jun 1 ; 82(6) : 1113-1117.
Stephens DP, Thomas JH, Ward LM, Currie BJ. Melioidosis causing critical illness: a review of 24 years of experience from the Royal Darwin Hospital ICU. Critical care medicine. 2016 Aug 1 ; 44(8) : 1500-1505.
Birnie E, Koh GC, Löwenberg EC, Meijers JC, Maude RR, Day NP, Peacock SJ, van der Poll T, Wiersinga WJ. Increased Von Willebrand factor, decreased ADAMTS13 and thrombocytopenia in melioidosis. PLoS neglected tropical diseases. 2017 Mar 15 ; 11(3) : e0005468.
Wiersinga WJ, Meijers JC, Levi M, van‘t Veer C, Day NP, Peacock SJ, van der Poll T. Activation of coagulation with concurrent impairment of anticoagulant mechanisms correlates with a poor outcome in severe melioidosis. Journal of Thrombosis and Haemostasis , 2008 Jan 1 ; 6(1) : 32-39.
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Churuangsuk C, Chusri S, Hortiwakul T, Charernmak B, Silpapojakul K. Characteristics, clinical outcomes and factors influencing mortality of patients with melioidosis in southern Thailand: A 10-year retrospective study. Asian Pacific journal of tropical medicine. 2016 Mar 31 ; 9(3) : 256-260.
Roslani AD, Tay ST, Puthucheary SD, Rukumani DV, Sam IC. Predictors of severe disease in melioidosis patients in Kuala Lumpur, Malaysia. The American journal of tropical medicine and hygiene, 2014 Dec 3 ; 91(6) : 1176-1178.
Zueter A, Yean CY, Abumarzouq M, Rahman ZA, Deris ZZ, Harun A. The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a North-Eastern state of Malaysia: a fifteen-year review. BMC infectious diseases, 2016 Jul 16 ; 16(1) : 333.
Chou DW, Chung KM, Chen CH, Cheung BM. Bacteremic melioidosis in southern Taiwan: clinical characteristics and outcome. Journal of the Formosan Medical Association. 2007 Dec 1 ; 106 (12) : 1013-1022.
Cheng AC, Currie BJ, Dance DA, Funnell SG, Limmathurotsakul D, Simpson AJ, Peacock SJ. Clinical definitions of melioidosis. The American journal of tropical medicine and hygiene, 2013 Mar 6 ; 88 (3) : 411-3.
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สมาคมโรคไตแห่งประเทศไทย. คำแนะนำสำหรับการดูแลผู้ป่วยโรคไตเรื้อรังก่อนการบำบัดทดแทนไต พ.ศ.2558 Clinical practice recommendation for the evaluation and management of chronic kidney disease in adults 2015. [อินเทอร์เน็ต]. 2558 [เข้าถึงเมื่อ 4 เมษายน 2560]. เข้าถึงได้จาก : http://24.nephrothai.org/images/10-11-2016/FinalCKD_2015.pdf
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal. 2015 Nov 21 ; 36(44) : 3075-128.
Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23 ; 315(8) : 775-87.
Dance D. Treatment and prophylaxis of melioidosis. International journal of antimicrobial agents. 2014 Apr 30 ; 43(4) : 310-318.
Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. New England Journal of Medicine. 2012 Sep 13 ; 367(11) : 1035-1044.
Bernard, R. (2000). Fundamentals of biostatistics (5th ed.). Duxbery : Thomson learning, 384-385.
Domthong P, Chaisuksant S, Sawanyawisuth K. What clinical factors are associated with mortality in septicemic melioidosis? A report from an endemic area. The Journal of Infection in Developing Countries. 2016 ; 10(04).
Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul ; 260(1) : 93-101.
Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, Rolim DB, Bertherat E, Day NP, Peacock SJ, Hay SI. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nature microbiology. 2016 Jan 11 ; 1 : 150-158.
Vuddhakul V, Tharavichitkul P, Na-Ngam N, Jitsurong S, Kunthawa B, Noimay P, Binla A,Thamlikitkul V. Epidemiology of Burkholderia pseudomallei in Thailand. The American journal of tropical medicine and hygiene. 1999 Mar 1 ; 60(3) : 458-461.
Reechaipichitkul W, Lulitanond V, Tantiwong P, Saelee R, Pisprasert V. Etiologies and treatment outcomes in patients hospitalized with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian journal of tropical medicine and public health. 2005 Jan 1 ; 36(1) : 156.
Chaowagul W, White NJ, Dance DA, Wattanagoon Y, Naigowit P, Davis TM, Looareesuwan S,Pitakwatchara N. Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand. Journal of Infectious Diseases. 1989 May 1 ; 159(5) : 890-899.
Kanoksil M, Jatapai A, Peacock SJ, Limmathurotsakul D. Epidemiology, microbiology and mortality associated with community-acquired bacteremia in northeast Thailand: a multicenter surveillance study. PloS one. 2013 Jan 18 ; 8(1) : e54714.
Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, Chaowagul W, Day NP, Peacock SJ. Increasing incidence of human melioidosis in Northeast Thailand. The American journal of tropical medicine and hygiene. 2010 Jun 1 ; 82(6) : 1113-1117.
Stephens DP, Thomas JH, Ward LM, Currie BJ. Melioidosis causing critical illness: a review of 24 years of experience from the Royal Darwin Hospital ICU. Critical care medicine. 2016 Aug 1 ; 44(8) : 1500-1505.
Birnie E, Koh GC, Löwenberg EC, Meijers JC, Maude RR, Day NP, Peacock SJ, van der Poll T, Wiersinga WJ. Increased Von Willebrand factor, decreased ADAMTS13 and thrombocytopenia in melioidosis. PLoS neglected tropical diseases. 2017 Mar 15 ; 11(3) : e0005468.
Wiersinga WJ, Meijers JC, Levi M, van‘t Veer C, Day NP, Peacock SJ, van der Poll T. Activation of coagulation with concurrent impairment of anticoagulant mechanisms correlates with a poor outcome in severe melioidosis. Journal of Thrombosis and Haemostasis , 2008 Jan 1 ; 6(1) : 32-39.
ChierakulW,Anunnatsiri S,Short JM, Maharjan B,Mootsikapun P,Simpson AJ, Limmathurotsakul D, Cheng AC, Stepniewska K, Newton PN, Chaowagul W. Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis. Clinical infectious diseases , 2005 Oct 15 ; 41(8) : 1105-1113.
Churuangsuk C, Chusri S, Hortiwakul T, Charernmak B, Silpapojakul K. Characteristics, clinical outcomes and factors influencing mortality of patients with melioidosis in southern Thailand: A 10-year retrospective study. Asian Pacific journal of tropical medicine. 2016 Mar 31 ; 9(3) : 256-260.
Roslani AD, Tay ST, Puthucheary SD, Rukumani DV, Sam IC. Predictors of severe disease in melioidosis patients in Kuala Lumpur, Malaysia. The American journal of tropical medicine and hygiene, 2014 Dec 3 ; 91(6) : 1176-1178.
Zueter A, Yean CY, Abumarzouq M, Rahman ZA, Deris ZZ, Harun A. The epidemiology and clinical spectrum of melioidosis in a teaching hospital in a North-Eastern state of Malaysia: a fifteen-year review. BMC infectious diseases, 2016 Jul 16 ; 16(1) : 333.
Chou DW, Chung KM, Chen CH, Cheung BM. Bacteremic melioidosis in southern Taiwan: clinical characteristics and outcome. Journal of the Formosan Medical Association. 2007 Dec 1 ; 106 (12) : 1013-1022.
Cheng AC, Currie BJ, Dance DA, Funnell SG, Limmathurotsakul D, Simpson AJ, Peacock SJ. Clinical definitions of melioidosis. The American journal of tropical medicine and hygiene, 2013 Mar 6 ; 88 (3) : 411-3.
Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I, Niederman M, Wunderink RG. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med, 2019 Feb ; 45(2) : 159-171
McCane DR, Hanson RL, Charles MA, Jacobsson LT, Pettitt DD, Bennett PH, Knowler WC. Comparison of tests for glycated haemoglobin and fasting and two hour plasma glucose concentrations as diagnostic methods for diabetes. Bmj., 1994 May 21 ; 308(6940) : 1323-1328.
สมาคมโรคไตแห่งประเทศไทย. คำแนะนำสำหรับการดูแลผู้ป่วยโรคไตเรื้อรังก่อนการบำบัดทดแทนไต พ.ศ.2558 Clinical practice recommendation for the evaluation and management of chronic kidney disease in adults 2015. [อินเทอร์เน็ต]. 2558 [เข้าถึงเมื่อ 4 เมษายน 2560]. เข้าถึงได้จาก : http://24.nephrothai.org/images/10-11-2016/FinalCKD_2015.pdf
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal. 2015 Nov 21 ; 36(44) : 3075-128.
Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M. Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23 ; 315(8) : 775-87.
Dance D. Treatment and prophylaxis of melioidosis. International journal of antimicrobial agents. 2014 Apr 30 ; 43(4) : 310-318.
Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. New England Journal of Medicine. 2012 Sep 13 ; 367(11) : 1035-1044.
Bernard, R. (2000). Fundamentals of biostatistics (5th ed.). Duxbery : Thomson learning, 384-385.
Domthong P, Chaisuksant S, Sawanyawisuth K. What clinical factors are associated with mortality in septicemic melioidosis? A report from an endemic area. The Journal of Infection in Developing Countries. 2016 ; 10(04).
Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul ; 260(1) : 93-101.
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2020-10-16
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Domthong, P. . (2020). Scoring system for prediction of severity and mortality in pulmonary melioidosis. Mahasarakham Hospital Journal, 17(2), 149–161. retrieved from https://he02.tci-thaijo.org/index.php/MKHJ/article/view/246713
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