Development of a respiratory severity score for hospitalized adults in a high HIV-prevalence setting—South Africa, 2010–2011

BMC Pulmonary Medicine

Research Article

Florette K. Treurnicht¹  Shabir A. Madhi²  Sibongile Walaza³  Cheryl Cohen³  Ebrahim Variava⁴  Marietjie Venter⁵  Carrie Reed⁶  Meredith McMorrow⁶  Adena Greenbaum⁷  Alexander J. Millman⁷  Adam L. Cohen⁸  Stefano Tempia⁹  Michelle J. Groome^1,10 

[1] Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa;Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa;Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;Department of Medicine, Klerksdorp-Tshepong Hospital Complex, Klerksdorp, South Africa;Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa;Global Disease Detection Center, Division of Global Health Protection, Centers for Disease Control and Prevention, Pretoria, South Africa;Zoonoses Research Program, Department of Medical Virology, University of Pretoria, Pretoria, South Africa;Influenza Division, Centers for Disease Control and Prevention, 30329, Atlanta, GA, USA;Influenza Division, Centers for Disease Control and Prevention, 30329, Atlanta, GA, USA;Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA;Influenza Division, Centers for Disease Control and Prevention, 30329, Atlanta, GA, USA;Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa;Influenza Division, Centers for Disease Control and Prevention, 30329, Atlanta, GA, USA;Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa;Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa;Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa;

关键词: Multivariable Logistic Regression Model;    Pneumonia Severity Index;    Acute Lower Respiratory Tract Infection;    Lower Respiratory Tract Infection;    Classification Tree Analysis;   

DOI  :  10.1186/s12890-017-0368-8

 received in 2016-04-05, accepted in 2017-01-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAcute lower respiratory tract infections (LRTI) are a frequent cause of hospitalization and mortality in South Africa; however, existing respiratory severity scores may underestimate mortality risk in HIV-infected adults in resource limited settings. A simple predictive clinical score for low-resource settings could aid healthcare providers in the management of patients hospitalized with LRTI.MethodsWe analyzed 1,356 LRTI hospitalizations in adults aged ≥18 years enrolled in Severe Acute Respiratory Illness (SARI) surveillance in three South African hospitals from January 2010 to December 2011. Using demographic and clinical data at admission, we evaluated potential risk factors for in-hospital mortality. We evaluated three existing respiratory severity scores, CURB-65, CRB-65, and Classification Tree Analysis (CTA) Score assessing for discrimination and calibration. We then developed a new respiratory severity score using a multivariable logistic regression model for in-hospital mortality and assigned points to risk factors based on the coefficients in the multivariable model. Finally we evaluated the model statistically using bootstrap resampling techniques.ResultsOf the 1,356 patients hospitalized with LRTI, 101 (7.4%) died while hospitalized. The CURB-65, CRB-65, and CTA scores had poor calibration and demonstrated low discrimination with c-statistics of 0.594, 0.548, and 0.569 respectively. Significant risk factors for in-hospital mortality included age ≥ 45 years (A), confusion on admission (C), HIV-infection (H), and serum blood urea nitrogen >7 mmol/L (U), which were used to create the seven-point ACHU clinical predictor score. In-hospital mortality, stratified by ACHU score was: score ≤1, 2.4%, score 2, 6.4%, score 3, 11.9%, and score ≥ 4, 29.3%. Final models showed good discrimination (c-statistic 0.789) and calibration (chi-square 1.6, Hosmer-Lemeshow goodness-of-fit p-value = 0.904) and discriminated well in the bootstrap sample (average optimism of 0.003).ConclusionsExisting clinical predictive scores underestimated mortality in a low resource setting with a high HIV burden. The ACHU score incorporates a simple set a risk factors that can accurately stratify patients ≥18 years of age with LRTI by in-hospital mortality risk. This score can quantify in-hospital mortality risk in an HIV-endemic, resource-limited setting with limited clinical information and if used to facilitate timely treatment may improve clinical outcomes.

【 授权许可】

CC BY   
© The Author(s). 2017