Outcome Predictors in Scrub Typhus Requiring Ventilator and Vasopressor Support.

Adhikari, S; Poudel, RS; Shrestha, S; Bhandari, N

Outcome Predictors in Scrub Typhus Requiring Ventilator and Vasopressor Support.

Adhikari, S Poudel, RS Shrestha, S Bhandari, N

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Publisher:: Nepal Health Research Council
Publication Type:: Journal Article
Citation:: Journal of Nepal Health Research Council, 2020, 17, (4), pp. 485-490
Issue Date:: 2020-01-21

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Field	Value	Language
dc.contributor.author	Adhikari, S
dc.contributor.author	Poudel, RS
dc.contributor.author	Shrestha, S
dc.contributor.author	Bhandari, N
dc.date.accessioned	2020-08-27T04:04:53Z
dc.date.available	2020-01-21
dc.date.available	2020-08-27T04:04:53Z
dc.date.issued	2020-01-21
dc.identifier.citation	Journal of Nepal Health Research Council, 2020, 17, (4), pp. 485-490
dc.identifier.issn	1727-5482
dc.identifier.issn	1999-6217
dc.identifier.uri	http://hdl.handle.net/10453/142397
dc.description.abstract	BACKGROUND:Age and serum creatinine are known to be predictors of mortality in scrub typhus patients admitted in intensive care unit. This study aimed to explore the factors predicting mortality in patients with scrub typhus requiring both ventilator and vasopressor support in our set up. METHODS:A retrospective analysis of 43 patients with scrub typhus (ELISA IgM positive, optical density ?0.5) admitted in Medical Intensive Care unit of Chitwan Medical College Teaching Hospital between April 2016 to September 2017 was performed considering recovery or death (poor outcome) as outcome measurement. Potential variables (p<0.25) from bivariate analysis were used to perform a multivariate logistic regression analysis (p<0.10) to predict mortality. RESULTS:The mortality rate was 56% (24/43). Acute respiratory distress syndrome and shock were observed in all 43 patients. The median (IQR) duration of ventilation use and vasopressor use was 53(101) hours and 48(79.5) hours, respectively. On bivariate analysis, an independent and statistically significant association of mortality with age in years (p=0.039), number of vasopressor use (p<0.001) and serum creatinine more than 1.4 mg/dl (p=0.012) was observed and on multivariate regression analysis, these variables were also the predictors of mortality (age in years: p=0.011, ?=0.115, OR=1.211, 95% CI=1.027-1.225; number of vasopressor use: p=0.009, ?=3.705, OR=40.647, 95% CI=2.532-652.425; serum creatinine more than 1.4 mg/dl: p=0.046, ?=-2.205, OR=0.110, 95% CI=0.013-0.961) Conclusions: In scrub typhus with ARDS and septic shock, increasing age and serum creatinine, and requiring more than one vasopressor to maintain blood pressure are at increased risk of mortality.
dc.format	Electronic
dc.language	eng
dc.publisher	Nepal Health Research Council
dc.relation.ispartof	Journal of Nepal Health Research Council
dc.relation.isbasedon	10.33314/jnhrc.v17i4.1991
dc.rights	info:eu-repo/semantics/openAccess
dc.title	Outcome Predictors in Scrub Typhus Requiring Ventilator and Vasopressor Support.
dc.type	Journal Article
utslib.citation.volume	17
utslib.location.activity	Nepal
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-08-27T04:04:50Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	17
utslib.citation.issue	4

Abstract:

BACKGROUND:Age and serum creatinine are known to be predictors of mortality in scrub typhus patients admitted in intensive care unit. This study aimed to explore the factors predicting mortality in patients with scrub typhus requiring both ventilator and vasopressor support in our set up. METHODS:A retrospective analysis of 43 patients with scrub typhus (ELISA IgM positive, optical density ?0.5) admitted in Medical Intensive Care unit of Chitwan Medical College Teaching Hospital between April 2016 to September 2017 was performed considering recovery or death (poor outcome) as outcome measurement. Potential variables (p<0.25) from bivariate analysis were used to perform a multivariate logistic regression analysis (p<0.10) to predict mortality. RESULTS:The mortality rate was 56% (24/43). Acute respiratory distress syndrome and shock were observed in all 43 patients. The median (IQR) duration of ventilation use and vasopressor use was 53(101) hours and 48(79.5) hours, respectively. On bivariate analysis, an independent and statistically significant association of mortality with age in years (p=0.039), number of vasopressor use (p<0.001) and serum creatinine more than 1.4 mg/dl (p=0.012) was observed and on multivariate regression analysis, these variables were also the predictors of mortality (age in years: p=0.011, ?=0.115, OR=1.211, 95% CI=1.027-1.225; number of vasopressor use: p=0.009, ?=3.705, OR=40.647, 95% CI=2.532-652.425; serum creatinine more than 1.4 mg/dl: p=0.046, ?=-2.205, OR=0.110, 95% CI=0.013-0.961) Conclusions: In scrub typhus with ARDS and septic shock, increasing age and serum creatinine, and requiring more than one vasopressor to maintain blood pressure are at increased risk of mortality.

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