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Updated: Aug 23, 2026
Simplified Whole Body Plethysmography to Characterize Lung Function During Respiratory Melioidosis
Published on: February 24, 2023
A proposed scoring system for predicting mortality in melioidosis
Allen C Cheng1, Susan P Jacups, Nicholas M Anstey
1Menzies School of Health Research and Northern Territory Clinical School, Flinders University, Casuarina, Australia. allenc@menzies.edu.au
Abstract:
Melioidosis, due to infection with the environmental organism Burkholderia pseudomallei, continues to be associated 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 < or = 3 (n = 140) was associated with a mortality of 8.6%, whereas a score of > or = 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.
Insights
This study developed a simple scoring system to predict mortality in patients with melioidosis, caused by Burkholderia pseudomallei. A higher melioidosis score, based on clinical and lab findings, indicates increased risk of death.
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.
