title: Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission.
abstract: OBJECTIVE
  Scrub typhus, a zoonotic rickettsial infection, is an important reason for intensive care unit (ICU) admission in the Indian subcontinent. We describe the clinical profile, organ dysfunction, and predictors of mortality of severe scrub typhus infection.
  
  
  METHODS
  Retrospective study of patients admitted with scrub typhus infection to a tertiary care university affiliated teaching hospital in India during a 21-month period.
  
  
  RESULTS
  The cohort (n = 116) aged 40.0 ± 15.2 years (mean ± SD), presented 8.5 ± 4.4 days after symptom onset. Common symptoms included fever (100%), breathlessness (68.5%), and altered mental status (25.5%). Forty-seven (41.6%) patients had an eschar. Admission APACHE-II score was 19.6 ± 8.2. Ninety-one (85.2%) patients had dysfunction of 3 or more organ systems. Respiratory (96.6%) and hematological (86.2%) dysfunction were frequent. Mechanical ventilation was required in 102 (87.9%) patients, of whom 14 (12.1%) were solely managed with non-invasive ventilation. Thirteen patients (11.2%) required dialysis. Duration of hospital stay was 10.7 ± 9.7 days. Actual hospital mortality (24.1%) was less than predicted APACHE-II mortality (36%; 95% Confidence interval 32-41). APACHE-II score and duration of fever were independently associated with mortality on logistic regression analysis.
  
  
  CONCLUSIONS
  In this cohort of severe scrub typhus infection with multi-organ dysfunction, survival was good despite high severity of illness scores. APACHE-II score and duration of fever independently predicted mortality.
authors.affiliation: Department of Internal Medicine, University of Colorado, Colorada, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Griffith
authors.affiliation: Department of Critical Care, Associate Professor, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
authors.affiliation: Department of Critical Care, Registrar, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Gunasekaran
authors.initials: G
authors.lastname: Karthik
authors.affiliation: Department of Critical Care, Registrar, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Ramakrishna
authors.affiliation: Department of Microbiology, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: John Antony Jude
authors.initials: JA
authors.lastname: Prakash
authors.affiliation: Department of Critical Care, Registrar, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Rajamanickam C
authors.initials: RC
authors.lastname: Kalki
authors.affiliation: Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: George M
authors.initials: GM
authors.lastname: Varghese
authors.affiliation: Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Anugragh
authors.initials: A
authors.lastname: Chrispal
authors.affiliation: Department of Critical Care, Associate Professor, Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Kishore
authors.initials: K
authors.lastname: Pichamuthu
authors.affiliation: Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Ramya
authors.initials: R
authors.lastname: Iyyadurai
authors.affiliation: Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India.
authors.forename: Ooriapadickal Cherian
authors.initials: OC
authors.lastname: Abraham
keywords: Intensive care; organ dysfunction; outcome; rickettsia; ventilation