title: Dermatological manifestations and relationship to outcomes of patients admitted to a medical intensive care unit: a study from a tertiary care hospital in India.
abstract: OBJECTIVE
  To determine the prevalence of dermatological manifestations in intensive care unit (ICU) patients and assess its impact on outcomes.
  
  
  METHODS
  This was a prospective cohort study of 1013 ICU patients admitted between December 2009 and April 2011. Patients were categorised following an initial screening (within 48 h) and subsequent daily review as those with dermatological manifestations in association with multisystem disorder (category 1), occurring due to treatment or critical illness (category 2), coincidental lesions (category 3) or primary dermatological conditions needing intensive care (category 4). Outcomes included mortality, duration of ventilation and hospitalisation. Factors associated with mortality were explored using univariate and multivariate analyses.
  
  
  RESULTS
  Dermatological manifestations were observed in 427 (42.2%) patients, predominantly of categories 1 (n=159) and 2 (n=160). Common aetiologies were infections (39.3%) and mechanical, thermal or physical injuries (32.8%). Primary dermatological conditions (n=33) included 21 patients with cutaneous infections, 3 with angioedema, 2 each with pemphigus, toxic epidermal necrolysis and psoriasis, and 1 each with Stevens-Johnson syndrome, drug hypersensitivity syndrome and crusted scabies. The presence of cutaneous lesions increased mortality risk (OR 1.56, 95% CI 1.20 to 2.03) and significantly (p<0.001) prolonged ventilation and hospitalisation. Mortality was higher (p<0.001) in patients in categories 4 (65.6%) and 2 (57.5%) compared to those without manifestations (35.5%). After adjusting for age, Acute Physiology And Chronic Health Evaluation II (APACHE-II) score, ventilation and dialysis, the association between dermatological manifestations and mortality was insignificant (OR 1.37, 95% CI 0.97 to 1.95).
  
  
  CONCLUSIONS
  Dermatological manifestations are common in ICU patients. Their presence may impact mortality and duration of ventilation and hospitalisation.
authors.affiliation: Department of Dermatology, Venereology and Leprosy, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Poonam
authors.initials: P
authors.lastname: Agrawal
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
authors.forename: Renu
authors.initials: R
authors.lastname: George
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D063128:Tertiary Health Care; D016896:Treatment Outcome