title: Severity predictors in eschar-positive scrub typhus and role of serum osteopontin.
abstract: We prospectively evaluated severity predictors in terms of host, microorganism, and treatment factors in 153 eschar-positive scrub typhus patients. Severity was assessed with the Acute Physiology and Chronic Health Evaluation (APACHE) II score (< 10 versus ≥ 10) and predefined criteria of severe complications. Genotypes of Orientia tsutsugamushi were determined. Independent risk factors for severity (APACHE II score ≥ 10) were old age, diabetes mellitus, serum osteopontin > 100 ng/mL, and a group of underlying diseases (congestive heart failure, cerebrovascular disease, chronic liver disease, bronchial asthma, and chronic obstructive lung diseases). Anemia (≤ 10 g/dL) and C-reactive protein > 10 mg/dL were indicators of current severity. Neither the delay in antibiotics administration nor strain types (Boryong, Taguchi, or Kanda/Kawasaki) contributed to the severity. The risk factors for severe complications were similar. Serum osteopontin > 100 ng/mL had a negative predictive value of 96% for severe complications. This marker can be used to rule out severe disease status.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. hswon1@snu.ac.kr
authors: Sang-Won
authors: SW
authors: Park
authors: Chang-Seop
authors: CS
authors: Lee
authors: Chi Kug
authors: CK
authors: Lee
authors: Yee Gyung
authors: YG
authors: Kwak
authors: Chisook
authors: C
authors: Moon
authors: Baek-Nam
authors: BN
authors: Kim
authors: Eu Suk
authors: ES
authors: Kim
authors: Jae Myung
authors: JM
authors: Kang
authors: Myoung-don
authors: MD
authors: Oh
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D016015:Logistic Models; D008264:Macrophages / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053495:Osteopontin / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D012612:Scrub Typhus / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D053495:Osteopontin