title: Hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction.
abstract: BACKGROUND
  Scrub typhus is a potentially fatal infectious disease caused by Orientia tsutsugamushi. There is little attention given to hepatic impairment in the adults with scrub typhus. This study investigated the incidence and the prognostic implications of hepatic impairment in patients with scrub typhus.
  
  
  METHODS
  We retrospectively reviewed a total of 143 adult patients with scrub typhus who were admitted between January 1999 and December 2010 in Guangdong province, China. The patients were divided into three groups, e.g., normal, mild, and moderate to severe groups based on the elevated serum ALT and/or total bilirubin levels. Furthermore, clinical characteristics and prognosis of the patient groups were compared.
  
  
  RESULTS
  109 patients (76.2%) had abnormal liver function. Among the patients with hepatic impairment 45 cases (31.4%), 54 cases (37.8%), and 10 cases (7.0%) had mild, moderate, and severe hepatic damage, respectively. The moderate to severe hepatic impairment group had higher levels of serum creatinine compared with that of normal hepatic function. The incidence of new onset of renal dysfunction - defined as peak serum creatinine > or = 176 micromol/L during hospital stay with no evidence of renal disease prior hospitalization - was 0% in the mild hepatic impairment group, 8.9% in the moderate hepatic impairment group, and 21.9% in the severe hepatic impairment group, (p = 0.005 for trend). Additionally, the patients with hepatic impairment (n = 109) had higher incidences of episodes of thrombocytopenia (45.9% vs. 8.82%, p < 0.001), hypoalbuminemia (50.5% vs. 11.8%, p < 0.001), new onset of renal dysfunction (16.5% vs. 0.0%, p = 0.011), and electrocardiogram abnormality (28.4% vs. 8.82%, p = 0.019) than the patients without hepatic impairment.
  
  
  CONCLUSIONS
  The degree of hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction.
authors.affiliation: Department of Infectious Diseases, the first Affiliated Hospital of Jinan University, Guangzhou 510630, China.
authors.forename: Xu-Jing
authors.initials: XJ
authors.lastname: Liang
authors.affiliation: Department of Infectious Diseases, the first Affiliated Hospital of Jinan University, Guangzhou 510630, China.
authors.forename: Si-Min
authors.initials: SM
authors.lastname: Huang
authors.affiliation: Department of Infectious Diseases, the eighth People's Hospital of Guangzhou, Guangzhou 510060, China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, the second People's Hospital of Yuebei, Shaoguan 512028, China.
authors.forename: Xian-Nv
authors.initials: XN
authors.lastname: Zhu
authors.affiliation: Department of Infectious Diseases, the first Affiliated Hospital of Jinan University, Guangzhou 510630, China.
authors.forename: Yong-Ping
authors.initials: YP
authors.lastname: Lu
authors.affiliation: Department of Infectious Diseases, the first Affiliated Hospital of Jinan University, Guangzhou 510630, China.
authors.forename: Berthold
authors.initials: B
authors.lastname: Hocher
authors.affiliation: Department of Infectious Diseases, the first Affiliated Hospital of Jinan University, Guangzhou 510630, China.
authors.forename: You-Peng
authors.initials: YP
authors.lastname: Chen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012612:Scrub Typhus / Q000503:physiopathology*