Validation of the Modified Multisystem Organ Failure Score as a Predictor of Mortality in Patients With AIDS-Related Pneumocystis carinii Pneumonia and Respiratory Failure

¹ From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; the Division of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
² From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada
³ From the British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
⁴ From the Department of Health Care and Epidemiology, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada
⁵ From the Department of Medicine, St. Paul's Hospital; Division of Respiratory Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
⁶ From the Department of Medicine, St. Paul's Hospital; the Division of Critical Care Medicine, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
⁷ From the British Columbia Center for Excellence in HIV/AIDS and the Department of Medicine, St. Paul's Hospital; Faculty of Medicine, University of British Columbia; and the Canadian HIV Trials Network, Vancouver, British Columbia, Canada

Study objectives: To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF).

Design: Retrospective chart review between April 1, 1991, and September 30, 1996.

Setting: University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada.

Patients: All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period.

Interventions: As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of < or 2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences.

Measurements and results: There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH.

Conclusions: Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.

Key Words: acquired immunodeficiency syndrome • acute respiratory failure • Pneumocystis carinii pneumonia • prognostic scores

Submitted on July 11, 1997
Accepted on December 26, 1997

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