Patient selection:
(1) AIDS
(2) cryptococcal infection (either positive antigen test or isolation from any body site)
Criteria for acute respiratory failure - one of the following:
(1) PaO2 to FIO2 ratio < 100
(2) respiratory rate > 40 breaths per minute for > 3 hours prior to death
Risk factors for acute respiratory failure:
(1) Black race
(2) LDH >= 500 IU/L (method and normal reference range not listed)
(3) presence of interstitial infiltrates on chest X-ray
(4) presence of cutaneous cryptococcal lesions
|
Parameter
|
Finding
|
Points
|
|
race
|
non-Black
|
0
|
|
|
Black
|
1
|
|
serum LDH
|
< 500 IU/L
|
0
|
|
|
>= 500 IU/L
|
1
|
|
chest X-ray
|
no interstitial infiltrates
|
0
|
|
|
interstitial infiltrates
|
1
|
|
cutaneous cryptococcal lesions
|
absent
|
0
|
|
|
present
|
1
|
total number of risk factors =
= SUM(points for all 4 risk factors)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The risk is greater as the number of risk factors increase.
The differential diagnosis includes Pneumocystis carinii pneumonia (PCP).
Performance:
• The sensitivity is 80% and specificity 90% for acute respiratory failure when all 4 risk factors are present.
• The odds ratios range from 7 (interstitial infiltrate) to 12 (serum LDH) to 17/18 (Black, skin lesions).
• The impact of HAART was not listed.
