恙虫病患者发生血栓栓塞事件的风险因素。

Risk factors of thromboembolic events in patients with scrub typhus.

机构信息

Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea.

Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea.

出版信息

PLoS Negl Trop Dis. 2024 Oct 14;18(10):e0012524. doi: 10.1371/journal.pntd.0012524. eCollection 2024 Oct.

DOI:10.1371/journal.pntd.0012524

PMID:39401259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11521240/

Abstract

BACKGROUND

Thromboembolic events are a well-recognized cause of in-hospital deaths of patients with infectious diseases. However, thromboembolic events in patients with scrub typhus, caused by Orientia tsutsugamushi have rarely been reported. This study aimed to assess risk factors associated with thromboembolic events in patients with scrub typhus.

METHODS

All 93 scrub typhus patients' diagnoses were confirmed serologically or by positive nested polymerase chain reaction (PCR). The clinical and laboratory findings from 12 scrub typhus patients with thromboembolic events and 81 scrub typhus patients with nonthromboembolic events were retrospectively studied. To determine the factors implicated in thromboembolic events, we performed multivariate logistic regression analysis using the six independent factors identified by the univariate analysis.

FINDINGS

The mean age of the patients in the thromboembolic group was 76.4 years (median, 76 years), and in nonthromboembolic group it was 64.6 years (median, 65 years) (P<0·001). Thromboembolic events were observed in 12 patients. These events included acute coronary syndrome (n = 5), acute limb ischemia (n = 4), ischemic stroke (n = 1), deep vein thrombosis combined with pulmonary thromboembolism (n = 1), and left common iliac artery aneurysm with a thrombus (n = 1). According to multivariate analysis, the following four factors were significantly associated with the thromboembolic events: 1) treatment with rifampin (OR = 57.63; P = 0.039; CI 1.230-2700.27)., 2) Taguchi genotype (OR = 41.5; P = 0.028; CI 1.5-1154.6), 3) atrial fibrillation (OR = 9.4; P = 0.034; CI 1.2-74.0), and 4) age (OR = 1.1; P = 0.046; CI 1.0-1.3).

CONCLUSIONS

Our study suggests that clinicians should be cautious when managing patients with scrub typhus to avoid the development of thromboembolic events, especially in patients with risk factors such as treatment with rifampin, Taguchi genotype, atrial fibrillation, and advanced age.

摘要

背景

血栓栓塞事件是传染病患者院内死亡的一个公认原因。然而，由恙虫东方体引起的恙虫病患者的血栓栓塞事件很少有报道。本研究旨在评估恙虫病患者血栓栓塞事件相关的危险因素。

方法

所有 93 例恙虫病患者的诊断均通过血清学或阳性巢式聚合酶链反应（PCR）证实。回顾性研究了 12 例恙虫病合并血栓栓塞事件和 81 例恙虫病非血栓栓塞事件患者的临床和实验室发现。为了确定与血栓栓塞事件相关的因素，我们使用单因素分析确定的六个独立因素进行了多变量 logistic 回归分析。

结果

血栓栓塞组患者的平均年龄为 76.4 岁（中位数 76 岁），非血栓栓塞组为 64.6 岁（中位数 65 岁）（P<0.001）。12 例患者发生血栓栓塞事件。这些事件包括急性冠状动脉综合征（n=5）、急性肢体缺血（n=4）、缺血性脑卒中（n=1）、深静脉血栓形成合并肺血栓栓塞症（n=1）和左髂总动脉动脉瘤合并血栓（n=1）。根据多变量分析，以下四个因素与血栓栓塞事件显著相关：1）利福平治疗（OR=57.63；P=0.039；95%CI 1.230-2700.27）；2）长尾基因型（OR=41.5；P=0.028；95%CI 1.5-1154.6）；3）心房颤动（OR=9.4；P=0.034；95%CI 1.2-74.0）；4）年龄（OR=1.1；P=0.046；95%CI 1.0-1.3）。