Gentile et al reported a score for evaluating a patient with cytomegalovirus interstitial pneumonia and allogeneic bone marrow receipt. This can help to identify a patient who may require more aggressive management. The authors are from University 'La Sapienza" in Rome,
Parameters:
(1) duration of fever (> 38.3°C) in days
(2) WBC count in 10^9/L
(3) platelet count in 10^9/L
(4) liver function tests
(5) degree of pulmonary disease
(6) gastrointestinal CMV disease
(7) mental status
(8) serum creatinine relative to best serum creatinine after transplantation
(9) nephrectomy or permanent dialysis
(10) arthritis or muscle wasting
(11) superinfection
(12) death
|
Parameter
|
Finding
|
Points
|
|
duration of fever
|
< 2 days
|
0
|
|
|
2 to 20 days
|
1
|
|
|
> 20 days
|
3
|
|
WBC count
|
<= 4 * (10^9/L (leukopenia)
|
1
|
|
|
> 4 * 10^9/L
|
0
|
|
platelet count
|
<= 4 * 10^9/L
|
1
|
|
|
> 4 * 10^9/L
|
0
|
|
liver function tests
|
< 2 times ULN
|
0
|
|
|
>= 2 times ULN
|
1
|
|
|
yes
|
3
|
|
pulmonary disease
|
no infiltrate
|
0
|
|
|
infiltrate without symptoms
|
1
|
|
|
infiltrate with symptoms
|
2
|
|
|
mechanical ventilation
|
3
|
|
GI CMV disease
|
no
|
0
|
|
|
yes
|
3
|
|
mental status
|
alert
|
0
|
|
|
lethargy
|
1
|
|
|
stupor
|
2
|
|
|
coma
|
3
|
|
creatinine
|
< 2 times best post-transplant value
|
0
|
|
|
>= 2 times best post-transplant value
|
2
|
|
|
nephrectomy or permanent dialysis
|
3
|
|
arthritis or muscle wasting
|
no
|
0
|
|
|
yes
|
2
|
|
superinfection
|
no
|
0
|
|
|
yes
|
3
|
|
death
|
no
|
0
|
|
|
yes
|
4
|
where:
• The points for death seem pointless.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum sore: 0
• maximum score: 25 (29 if death not scored)
• A score > 8 is 100% sensitive and 88% specific for predicting mortality.
• Receipt of gancyclovir was the most important determinant of outcome.
