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The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

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  • 1 Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia;
  • | 2 Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;
  • | 3 Infectious Diseases Unit, Western Health, Victoria, Australia;
  • | 4 Kirby Institute, University of New South Wales, Sydney, Australia;
  • | 5 James Cook University, Cairns Campus, Cairns, Queensland, Australia

ABSTRACT.

Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.

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Author Notes

Address correspondence to Josh Hanson, Kirby Institute, Level 6, Wallace Wurth Building, High Street, UNSW, Kensington NSW 2052, Australia. E-mail: jhanson@kirby.unsw.edu.au

Disclosure: Ethics approval was provided by the Far North Queensland Human Research Ethics Committee (HREC/2020/QCH/64424–1442). As the data were retrospective and de-identified, the Committee waived the requirement for informed consent.

Authors’ addresses: Kris Salaveria, Yu-Hsuan Liu, and Markus Ott, Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia, E-mails: kris.salaveria@health.qld.gov.au, yu-hsuan.liu@health.qld.gov.au, and markus.ott@health.qld.gov.au. Simon Smith and Richard Bagshaw, Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia, E-mails: simon.smith2@health.qld.gov.au and richard.bagshaw@health.qld.gov.au. Alexandra Stewart, Infectious Diseases Unit, Western Health, Victoria, Australia, E-mail: alexandra.stewart03@gmail.com. Matthew Law, Kirby Institute, University of New South Wales, Sydney, Australia, E-mail: mlaw@kirby.unsw.edu.au. Angus Carter, Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia, and James Cook University, Cairns Campus, Cairns, Queensland, Australia, E-mail: angus.carter@health.qld.gov.au. Josh Hanson, Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia, and Kirby Institute, University of New South Wales, Sydney, NSW, Australia, E-mail: jhanson@kirby.unsw.edu.au.

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