Predictors of mortality in scrub typhus: A hospital-based study.

Abstract

Scrub typhus is a potentially life-threatening febrile illness associated with serious complications viz. pneumonia, acute respiratory distress syndrome, hepatic failure, acute kidney injury, encephalitis, and shock often culminating in mortality. We aimed to identify the predictors of mortality in scrub typhus. This prospective observational study was conducted in a tertiary referral hospital of the north Indian state of Uttarakhand on in-patients of scrub typhus hospitalized over 1 year. Of the 109 cases studied (54.1% males), 44% were aged <40 years. Fever (95.4%), loss of appetite (55.9%), myalgia (47.7%), pallor (40.3%), hepatomegaly (27.5%), eschar (17.4%), and splenomegaly (13.7%) were the main clinical features. Hepatic transaminitis (69.7%), renal insufficiency (44.0%), respiratory failure (37.6%), shock (33.9%), central nervous system (CNS) involvement (21.1%), and severe anemia (7.3%) were the major complications at presentations. Intensive care and mechanical ventilation were utilized in 33.9% and 15.5% of cases, respectively. Multivariate logistic regression suggested renal insufficiency, CNS involvement, shock, severe anemia, and mechanical ventilation independently associated with death. Respiratory failure, renal insufficiency and neurological involvement, mechanical ventilation, shock, and severe anemia at presentation predict mortality in scrub typhus.