Patient selection: disseminated histoplasmosis in a patient with AIDS
Risk factors for death:
(1) anemia, with hemoglobin < 8.0 g/dL (odds ratio 4)
(2) acute renal failure (odds ratio 3)
(3) respiratory insufficiency (odds ratio 12)
where:
• Respiratory insufficiency was defined as the need for mechanical ventilation.
• Acute renal failure was defined as (a) a serum creatinine > 1.5 mg/dL, (b) an increase in creatinine > 0.5 mg/dL over baseline, OR (c) an increase by > 50%.
An increased serum AST (>= 2.5 times the upper limit of normal) was also associated with mortality, but the odds ratio was 1.
This data can be used to create a risk score as follows:
|
Parameter
|
Finding
|
Points
|
|
hemoglobin
|
>= 8 g/dL
|
0
|
|
|
< 8 g/dL
|
1
|
|
acute renal failure
|
absent
|
0
|
|
|
present
|
1
|
|
respiratory insufficiency
|
absent
|
0
|
|
|
present
|
4
|
total risk score =
= SUM(points for all 3 parameters)
|
Total Score
|
Risk of Mortality
|
|
0
|
low
|
|
1
|
low to moderate
|
|
2
|
moderate
|
|
4
|
moderate to high
|
|
5
|
high
|
|
6
|
very high
|
