Severity assessment in melioidosis pneumonia: what is the most appropriate score or factor?

Abstract

Abstract Background and objective Pneumonia induced by Burkholderia pseudomallei is a common clinical entity of melioidosis. Along with the development of melioidosis rapid tests, prognostic assessment for melioidosis pneumonia (MP) patients at admission is essential. Our study aims to evaluate the validity of the mortality prognostic score for acute melioidosis and pneumonic scores in predicting MP patients. Methods A prospective study was conducted from the late 2019 to the early 2022 at the respiratory department of the largest hospital in Southern Vietnam. Results Of 66 MP patients, mean age 51.17 ± 11.02, male/female ratio 57/9, and 89.39% presented with acute pulmonary melioidosis. The rate of need for intensive respiratory or vasopressor support (IRVS) was 34.8% and the mortality at discharged time was 25.80%. The areas under ROC curve (AUCs) of PSI, CURB-65, and SMART-COP in predicting the IRVS need were 0.813 (p < 0.001), 0.868 (p < 0.001), and 0.910 (p < 0.001), respectively. The AUCs of PSI, CURB-65, SMART-COP, and the mortality score of acute melioidosis in predicting the death outcome were 0.698 (p = 0.017), 0.797 (p < 0.001), 0.797 (p < 0.001), and 0.663 (p = 0.047), respectively. The sensitivity, specificity, and positive likelihood ratio for CURB-65 score ≥ 2 in predicting the IRVS need and the mortality were 69.57% and 70.59%, 90.70% and 83.67%, 7.48 and 11.53, respectively. Conclusions MP could present mild to severe clinical scenario with high mortality among severe MP cases. The simple CURB-65 score could be useful in predicting severe MP.