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Survival-Based Severity Index of Turner et al for Patients with AIDS

Purpose: To determine the illness severity of a patient with AIDS using the severity index of Turner et al.

Description

Turner et al developed a severity index for patients with AIDS that correlated with survival before the introduction of HAART. It is based on the condition that defines the onset of AIDS and the severity of complications in the 3 months after the first diagnosis of an AIDS-defining condition. The authors are from Thomas Jefferson University in Philadelphia and the New York State Department of Social Services


Diagnosis

Group

Kaposi's sarcoma, no organ involvement

1

herpes simplex, mucocutaneous

1

disseminated tuberculosis

1

Candida esophagitis

1

wasting syndrome

1

Salmonella sepsis

1

Pneumocystis carinii pneumonia

2

disseminated atypical mycobacterial infection

3

Kaposi's sarcoma with organ involvement

3

cryptococcosis

3

herpes simplex infection with organ involvement

3

disseminated cytomegalovirus infection

3

cryptosporidiosis or isosporiasis

3

toxoplasmosis

3

disseminated histoplasmosis

3

AIDS-related lymphoma

3

AIDS dementia complex

3

disseminated coccidioidomycosis

3

progressive multifocal leukoencephalopathy

3

 

 

Complications

Severity Level

none within 3 month interval after onset of AIDS

0

complication from the least severe level within 3 month interval after onset of AIDS

1

complication from the moderately severe level within 3 month interval after onset of AIDS

2

complication from the most severe level within 3 month interval after onset of AIDS

3

 

 

Examples of Complication

Severity Level

Candida esophagitis

1

bacterial pneumonia

1

pulmonary tuberculosis

1

chronic mucocutaneous herpes simplex

1

cutaneous Kaposi's sarcoma

1

visceral Kaposi's sarcoma

2

CMV retinitis

2

cryptococcal meningitis

2

toxoplasmosis

2

disseminated tuberculosis

2

respiratory failure

3

AIDS dementia complex

3

HIV-related cardiomyopathy

3

AIDS-associated lymphoma

3

CMV colitis

3

 

 

 

Severity Level of Subsequent Complications

AIDS Defining Diagnosis Group

0 (none)

1 (mild)

2 (moderate)

3 (severe)

Group 1

A

C

D

D

Group 2

B

C

D

D

Group 3

C

C

D

D

 

 

Index

Severity

50% Survival

A

minimal

43 months

B

mild to moderate

22 months

C

moderate to marked

18 months

D

most

13 months

from Figure 3, page 1067

 

Limitations:

• With the development of highly active anti-retroviral therapy (HAART) the survival of patients has markedly improved.


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Specialty

Objective

ICD-10