Adhikari Shital, Poudel Ramesh Sharma, Shrestha Shakti, Lamichhane Praves
Pulmonology and Critical Care Unit, Department of Internal Medicine, Chitwan Medical College Teaching Hospital, Chitwan, Nepal.
Hospital Pharmacy, Chitwan Medical College Teaching Hospital, Chitwan, Nepal.
Interdiscip Perspect Infect Dis. 2018 Jun 3;2018:4867958. doi: 10.1155/2018/4867958. eCollection 2018.
This study aimed to explore the predictors of mortality from scrub typhus infection in patients requiring intensive care unit (ICU) admission.
A retrospective study was conducted on 120 patients with serum ELISA IgM positive for scrub typhus (optical density ≥ 0.5) admitted at the medical ICU of Chitwan Medical College Teaching Hospital between April 2016 and September 2017. Data was extracted from patient medical records and electronic database of the hospital. The outcome measurement was mortality (Yes/No) due to the infection. A multivariate binary logistic regression analysis ( < 0.10) using potential variables from bivariate analysis ( < 0.25) was adjusted to predict the mortality.
The mortality rate was 20% (24/120). Factors associated with mortality, as found using bivariate analysis, were heart rate > 100/minute ( < 0.001), systolic blood pressure < 90 mmHg ( = 0.025), diastolic blood pressure < 60 mmHg ( = 0.032), serum creatinine > 1.4 mg/dl ( < 0.001), acute kidney injury requiring dialysis ( = 0.029), acute respiratory distress syndrome ( < 0.001), and shock requiring vasopressor ( < 0.001). Regression analysis showed age (odds ratio [OR] = 1.063; 95% CI = 1.010-1.118; = 0.019) and serum creatinine (OR = 1.063; 95% CI = 1.010-1.118; = 0.019) as significant predictors of poor outcome.
Older age and high serum creatinine were found to be independent predictors of poor outcome in patients with scrub typhus admitted in medical ICU.
本研究旨在探讨入住重症监护病房（ICU）的恙虫病感染患者的死亡预测因素。
对2016年4月至2017年9月期间在奇旺医学院教学医院内科ICU住院的120例血清ELISA IgM恙虫病阳性（光密度≥0.5）患者进行回顾性研究。数据从患者病历和医院电子数据库中提取。结局指标是感染导致的死亡（是/否）。使用二元分析（<0.25）中的潜在变量进行多变量二元逻辑回归分析（<0.10）以预测死亡率。
死亡率为20%（24/120）。二元分析发现与死亡率相关的因素有心率>100次/分钟（<0.001）、收缩压<90 mmHg（=0.025）、舒张压<60 mmHg（=0.032）、血清肌酐>1.4 mg/dl（<0.001）、需要透析的急性肾损伤（=0.029）、急性呼吸窘迫综合征（<0.001）和需要血管升压药的休克（<0.001）。回归分析显示年龄（比值比[OR]=1.063；95%可信区间[CI]=1.010-1.118；=0.019）和血清肌酐（OR=1.063；95% CI=1.010-1.118；=0.019）是不良结局的显著预测因素。
发现年龄较大和血清肌酐水平较高是内科ICU收治的恙虫病患者不良结局的独立预测因素。
