Predictors of Mortality in Scrub Typhus Infection Requiring Intensive Care Admission in Tertiary Healthcare Centre of Nepal

Abstract

Introduction This study aimed to explore the predictors of mortality from scrub typhus infection in patients requiring intensive care unit (ICU) admission. Materials and Methods 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 (p < 0.10) using potential variables from bivariate analysis (p < 0.25) was adjusted to predict the mortality. Results The mortality rate was 20% (24/120). Factors associated with mortality, as found using bivariate analysis, were heart rate > 100/minute (p < 0.001), systolic blood pressure < 90 mmHg (p = 0.025), diastolic blood pressure < 60 mmHg (p = 0.032), serum creatinine > 1.4 mg/dl (p < 0.001), acute kidney injury requiring dialysis (p = 0.029), acute respiratory distress syndrome (p < 0.001), and shock requiring vasopressor (p < 0.001). Regression analysis showed age (odds ratio [OR] = 1.063; 95% CI = 1.010–1.118; p = 0.019) and serum creatinine (OR = 1.063; 95% CI = 1.010–1.118; p = 0.019) as significant predictors of poor outcome. Conclusion Older age and high serum creatinine were found to be independent predictors of poor outcome in patients with scrub typhus admitted in medical ICU.

An outbreak investigation of scrub typhus in Nepal: confirmation of local transmission

“…This type of baseline information is required for a country to formulate appropriate guidelines and pave strategies for scrub typhus control. Apart from a handful of reports discussing the human cases [ 7 – 10 , 22 , 23 ], no study has explored whether the human-host-vector/reservoir-pathogen cycle is maintained in Nepal. This ecological chain is essential to understand a sudden outbreak of any magnitude [ 24 ].…”

Clinical Profile and Predictors of Intensive Care Unit Admission in Pediatric Scrub Typhus: A Retrospective Observational Study from North India

“…Several outcome predictors have been studied including duration of fever, absence of eschar, thrombocytopenia, ARDS, oliguric AKI, CNS dysfunction, etc., but none have been consistently reported. 27 , 28 Despite the severity of illness and high prevalence of multiorgan dysfunction, early treatment with doxycycline and good supportive care had shown favorable outcome in adults. 29 We believe that our study focusing on pediatric scrub typhus requiring intensive care would be a valuable addition to the recent descriptive literature addressing seasonal tropical fevers in India.…”

Scrub Typhus: Report of Three Cases From Rural Nepal and a Brief Literature Review

“…Shock requiring vasoactive agents, central nervous system (CNS) dysfunction, and renal failure were found to be the independent predictors of mortality [7]. Similarly, mortality in ICU admitted patients of scrub typhus was found to be 20% in a recent study in Nepal [13]. Even with the laboratory tests, 94.3% of the cases were not definitively diagnosed, according to a surveillance data [1].…”

“…Such instances are excellent lessons for the physicians to treat the condition early enough to lessen hospital stay and avoid mortality. Morbidity and mortality associated with scrub typhus can be reduced significantly by early recommended empiric therapy in clinically suspected cases of scrub typhus [ 13 ].…”