0
Articles |

Validation of the Modified Multisystem Organ Failure Score as a Predictor of Mortality in Patients With AIDS-Related Pneumocystis carinii Pneumonia and Respiratory Failure

David M. Forrest; Ognjenka Djurdjev; Carlos Zala; Joel Singer; Lindsay Lawson; James A. Russell; Julio S.G. Montaner
Author and Funding Information

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Affiliations: From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada,  From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,  From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada


1998 by the American College of Chest Physicians


Chest. 1998;114(1):199-206. doi:10.1378/chest.114.1.199
Text Size: A A A
Published online

Abstract

Study objectives: To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF).

Design: Retrospective chart review between April 1, 1991, and September 30, 1996.

Setting: University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada.

Patients: All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period.

Interventions: As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of < or ≥2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences.

Measurements and results: There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH.

Conclusions: Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543