Karthik Gunasekaran, Sudarsan Thomas Isaiah, Peter John Victor, Sudarsanam Thambu, Varghese George M, Kundavaram Paul, Sathyendra Sowmya, Iyyadurai Ramya, Pichamuthu Kishore
Department of Medicine, Christian Medical College, Vellore 632004, India.
Medical Intensive Care Unit, Christian Medical College, Vellore 632004, India.
World J Crit Care Med. 2018 Feb 4;7(1):16-23. doi: 10.5492/wjccm.v7.i1.16.
To study the spectrum of cardiac manifestations in scrub typhus infection and assess its relationship to outcomes.
Demographic data, electrocardiographic (ECG) changes, left ventricular (LV) systolic and diastolic function, myocardial injury (defined as troponin T > 14 pg/mL), and pericardial effusion were documented. Myocarditis was diagnosed when myocardial injury was associated with global LV systolic dysfunction. The relationship between myocarditis and outcomes was assessed using logistic regression analysis and expressed as odds ratio (OR) with 95%CI.
The cohort ( = 81; 35 males) aged 49.4 ± 16.1 years (mean, SD) presented 8.1 ± 3.1 d after symptom onset. The APACHE-II score was 15.7 ± 7.0. Forty-eight (59%) patients were ventilated, and 46 (56%) required vasoactive agents. Mortality was 9.9%. ECG changes were non-specific; sinus tachycardia was the most common finding. Myocardial injury was evident in 61.7% of patients and LV systolic dysfunction in 30.9%. A diagnosis of myocarditis was made in 12.3%. In addition, seven patients with regional wall motion abnormalities had LV systolic dysfunction and elevated cardiac enzymes. Mild diastolic dysfunction was observed in 18 (22%) patients. Mild to moderate pericardial effusion was seen in 51%. On multivariate logistic regression analysis, patients with myocarditis tended to be older (OR = 1.04, 95%CI: 0.99-1.09), had shorter symptom duration (OR = 0.69, 95%CI: 0.49-0.98), and tended to stay longer in hospital (OR = 1.17, 95%CI: 0.98-1.40). Myocarditis was not associated with increased mortality.
In scrub typhus infection, cardiac manifestations are frequent and associated with increased morbidity but not mortality.
研究恙虫病感染中心脏表现的谱，并评估其与预后的关系。
记录人口统计学数据、心电图（ECG）变化、左心室（LV）收缩和舒张功能、心肌损伤（定义为肌钙蛋白T>14 pg/mL）和心包积液。当心肌损伤与整体LV收缩功能障碍相关时，诊断为心肌炎。使用逻辑回归分析评估心肌炎与预后的关系，并以比值比（OR）和95%置信区间（CI）表示。
该队列（n = 81；35名男性）年龄为49.4±16.1岁（均值，标准差），症状出现后8.1±3.1天就诊。急性生理与慢性健康状况评分系统II（APACHE-II）评分为15.7±7.0。48例（59%）患者需要机械通气，46例（56%）需要血管活性药物。死亡率为9.9%。ECG变化无特异性；窦性心动过速是最常见的表现。61.7%的患者有心肌损伤，30.9%的患者有LV收缩功能障碍。12.3%的患者被诊断为心肌炎。此外，7例有节段性室壁运动异常的患者有LV收缩功能障碍和心肌酶升高。18例（22%）患者观察到轻度舒张功能障碍。51%的患者有轻度至中度心包积液。多因素逻辑回归分析显示，心肌炎患者往往年龄较大（OR = 1.04，95%CI：0.99-1.09），症状持续时间较短（OR = 0.69，95%CI：0.49-0.98），且住院时间往往较长（OR = 1.17，95%CI：0.98-1.40）。心肌炎与死亡率增加无关。
在恙虫病感染中，心脏表现常见，且与发病率增加相关，但与死亡率无关。
