Griffith Mathew, Peter John Victor, Karthik Gunasekaran, Ramakrishna Kartik, Prakash John Antony Jude, Kalki Rajamanickam C, Varghese George M, Chrispal Anugragh, Pichamuthu Kishore, Iyyadurai Ramya, Abraham Ooriapadickal Cherian
Department of Internal Medicine, University of Colorado, Colorada, USA.
Department of Critical Care, Associate Professor, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
Indian J Crit Care Med. 2014 Aug;18(8):497-502. doi: 10.4103/0972-5229.138145.
Scrub typhus, a zoonotic rickettsial infection, is an important reason for intensive care unit (ICU) admission in the Indian subcontinent. We describe the clinical profile, organ dysfunction, and predictors of mortality of severe scrub typhus infection.
Retrospective study of patients admitted with scrub typhus infection to a tertiary care university affiliated teaching hospital in India during a 21-month period.
The cohort (n = 116) aged 40.0 ± 15.2 years (mean ± SD), presented 8.5 ± 4.4 days after symptom onset. Common symptoms included fever (100%), breathlessness (68.5%), and altered mental status (25.5%). Forty-seven (41.6%) patients had an eschar. Admission APACHE-II score was 19.6 ± 8.2. Ninety-one (85.2%) patients had dysfunction of 3 or more organ systems. Respiratory (96.6%) and hematological (86.2%) dysfunction were frequent. Mechanical ventilation was required in 102 (87.9%) patients, of whom 14 (12.1%) were solely managed with non-invasive ventilation. Thirteen patients (11.2%) required dialysis. Duration of hospital stay was 10.7 ± 9.7 days. Actual hospital mortality (24.1%) was less than predicted APACHE-II mortality (36%; 95% Confidence interval 32-41). APACHE-II score and duration of fever were independently associated with mortality on logistic regression analysis.
In this cohort of severe scrub typhus infection with multi-organ dysfunction, survival was good despite high severity of illness scores. APACHE-II score and duration of fever independently predicted mortality.
恙虫病是一种人兽共患的立克次体感染疾病，是印度次大陆地区患者入住重症监护病房（ICU）的重要原因。我们描述了重症恙虫病感染的临床特征、器官功能障碍及死亡预测因素。
对印度一所大学附属三级教学医院在21个月期间收治的恙虫病感染患者进行回顾性研究。
该队列患者（n = 116）年龄为40.0 ± 15.2岁（均值 ± 标准差），症状出现后8.5 ± 4.4天入院。常见症状包括发热（100%）、气促（68.5%）和精神状态改变（25.5%）。47例（41.6%）患者有焦痂。入院时急性生理与慢性健康状况评分系统（APACHE-II）评分为19.6 ± 8.2。91例（85.2%）患者存在3个或更多器官系统功能障碍。呼吸功能障碍（96.6%）和血液系统功能障碍（86.2%）较为常见。102例（87.9%）患者需要机械通气，其中14例（12.1%）仅采用无创通气治疗。13例（11.2%）患者需要透析治疗。住院时间为10.7 ± 9.7天。实际医院死亡率（24.1%）低于预测的APACHE-II死亡率（36%；95%置信区间32 - 41）。经逻辑回归分析，APACHE-II评分和发热持续时间与死亡率独立相关。
在这组伴有多器官功能障碍的重症恙虫病感染患者中，尽管疾病严重程度评分较高，但生存率良好。APACHE-II评分和发热持续时间可独立预测死亡率。
