A proposed scoring system for predicting mortality in melioidosis

Area of Science:

• Infectious Diseases
• Clinical Medicine
• Epidemiology

Background:

• Melioidosis, caused by Burkholderia pseudomallei, has a high mortality rate despite advances in antibiotic treatment.
• Identifying patients at higher risk of death from acute melioidosis is crucial for timely intervention.

Purpose of the Study:

• To develop and validate a simple scoring system using readily available clinical and laboratory data to predict mortality in acute melioidosis patients.
• To identify key predictors of mortality in melioidosis at the time of hospital admission.

Main Methods:

• Prospective data collection from October 1989 to June 2002 from patients with culture-confirmed melioidosis.
• Selection of variables reflecting organ dysfunction available at admission, including clinical findings and baseline laboratory tests.
• Development of a melioidosis score based on pneumonia, age, serum urea, serum bilirubin, lymphocyte count, and serum bicarbonate.

Main Results:

• Mortality was predicted by pneumonia, age, serum urea, serum bilirubin, lymphocyte count, and serum bicarbonate.
• A melioidosis score of ≤3 was associated with 8.6% mortality (n=140).
• A melioidosis score of ≥4 was associated with a significantly higher mortality of 44.6% (n=112).

Conclusions:

• The developed melioidosis scoring system can identify patients at higher risk of death.
• This score may aid in targeting intensive interventions, such as ICU admission and early meropenem use, for high-risk patients.
• External validation of the scoring system is recommended.