title: Clinical outcomes and prognostic factors for patients with Vibrio vulnificus infections requiring intensive care: a 10-yr retrospective study.
abstract: OBJECTIVE
  Vibrio vulnificus infection is uncommon but potentially life-threatening. The aim of this study was to evaluate clinical outcomes and prognostic factors for patients with V. vulnificus infections admitted to an intensive care unit.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Multidisciplinary intensive care unit in a 2300-bed teaching hospital.
  
  
  METHODS
  Eighty-five adult patients (≥ 18 yrs) with V. vulnificus infections who required intensive care were enrolled and reviewed during a 10-yr period.
  
  
  METHODS
  None.
  
  
  RESULTS
  Thirty-four of the 85 patients died, giving an intensive care unit mortality rate of 40%. The mean Acute Physiology and Chronic Health Evaluation II score on intensive care unit admission was 18.4 (95% confidence interval, 17.1-19.8). The most common underlying disease was hepatic disease (48%) followed by diabetes mellitus (22%). Multivariate analysis showed that risk factors for intensive care unit mortality were the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis (relative risk, 2.4; 95% confidence interval, 1.3-4.5; p = .006), skin/soft tissue infections involving two or more limbs (relative risk, 2.5; 95% confidence interval, 1.1-5.7; p = .025), and higher Acute Physiology and Chronic Health Evaluation II scores on intensive care unit admission (relative risk, 1.2; 95% confidence interval, 1.1-1.3; p = .0001). In contrast, surgical treatment < 24 hrs after arrival was inversely associated with intensive care unit mortality (relative risk, 0.35; 95% confidence interval, 0.15-0.79; p = .012). In addition, the area under the receiver operating characteristic curve for Acute Physiology and Chronic Health Evaluation II for predicting intensive care unit mortality was 0.945 (95% confidence interval, 0.873-0.983; p = .0001). An optimal cutoff Acute Physiology and Chronic Health Evaluation II score of ≥ 20 had a sensitivity of 97% and a specificity of 86% with a 41.4-fold increased risk of fatality (p = .0003).
  
  
  CONCLUSIONS
  This study found that V. vulnificus-infected patients with hemorrhagic bullous skin lesions/necrotizing fasciitis, skin/soft tissue infections involving two or more limbs, or higher Acute Physiology and Chronic Health Evaluation II scores have high risks of intensive care unit mortality. However, patients receiving prompt surgical treatments within 24 hrs after admission have better prognoses.
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Shiuan-Chih
authors.initials: SC
authors.lastname: Chen
authors.forename: Khee-Siang
authors.initials: KS
authors.lastname: Chan
authors.forename: Wai-Nang
authors.initials: WN
authors.lastname: Chao
authors.forename: Po-Hui
authors.initials: PH
authors.lastname: Wang
authors.forename: Ding-Bang
authors.initials: DB
authors.lastname: Lin
authors.forename: Kwo-Chang
authors.initials: KC
authors.lastname: Ueng
authors.forename: Sheng-Hung
authors.initials: SH
authors.lastname: Kuo
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Chen
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003422:Critical Care / Q000706:statistics & numerical data; D019115:Fasciitis, Necrotizing / Q000209:etiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014735:Vibrio Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D041261:Vibrio vulnificus
chemical_list: D000900:Anti-Bacterial Agents