Gupta Anish, Juneja Deven, Singh Omender, Garg Suneel Kumar, Arora Varun, Deepak Desh
Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India.
Indian J Crit Care Med. 2018 Jan;22(1):5-9. doi: 10.4103/ijccm.IJCCM_336_17.
Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome.
All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated. Primary outcome measured was 28-day mortality and secondary outcomes measured were length of hospital and ICU stay and the need for vasopressor support, renal replacement therapy (RRT), and mechanical ventilation (MV). Logistic regression analysis was performed to identify factors predicting mortality.
The most common complaints were fever (96.67%) and altered sensorium (56.67%). Mean admission APACHE II and SOFA scores were 17.28 ± 7.9 and 7.15 ± 4.2, respectively. Fifty-one patients had underlying comorbidities. Vasopressors were required by 46.76%; RRT by 26.67%, and MV by 58.33%, respectively. The 28-day mortality was 36.67%. High APACHE II score (odds ratio: 1.535; 95% confidence interval: 1.053-2.237; = 0.026) and need for dialysis (odds ratio: 833.221; 95% confidence interval: 1.853-374,664.825; = 0.031) could independently predict mortality.
Patients with chikungunya fever may require ICU admission for organ failure. They are generally elderly patients with underlying comorbidities. Despite aggressive resuscitation and organ support, these patients are at high risk of death. Admission APACHE II score and need for dialysis may predict patients at higher risk of death.
基孔肯雅热通常是一种轻症疾病，很少需要入住重症监护病房（ICU）。然而，某些人群可能会出现器官功能障碍而需要入住ICU。本研究的目的是评估入住ICU的基孔肯雅热患者的临床特征和病程，并确定与不良预后相关的因素。
本研究纳入了所有入住ICU的基孔肯雅热患者。计算入院时的急性生理与慢性健康状况评估系统（APACHE）II评分和序贯器官衰竭评估（SOFA）评分。主要观察指标为28天死亡率，次要观察指标为住院时间和ICU住院时间，以及使用血管活性药物支持、肾脏替代治疗（RRT）和机械通气（MV）的需求。进行逻辑回归分析以确定预测死亡率的因素。
最常见的症状是发热（96.67%）和意识改变（56.67%）。入院时APACHE II评分和SOFA评分的平均值分别为17.28±7.9和7.15±4.2。51例患者有基础合并症。分别有46.76%的患者需要使用血管活性药物、26.67%的患者需要进行RRT、58.33%的患者需要进行MV。28天死亡率为36.67%。高APACHE II评分（比值比：1.535；95%置信区间：1.053 - 2.237；P = 0.026）和需要透析（比值比：833.221；95%置信区间：1.853 - 374,664.825；P = 0.031）可独立预测死亡率。
基孔肯雅热患者可能因器官衰竭而需要入住ICU。他们通常是有基础合并症的老年患者。尽管进行了积极的复苏和器官支持，这些患者仍有很高的死亡风险。入院时APACHE II评分和透析需求可能预测死亡风险较高的患者。
