Risk factors of scrub typhus complicated with acute respiratory distress syndrome / 中华传染病杂志

ABSTRACT

Objective@#To investigate the risk factors of scrub typhus complicated with acute respiratory distress syndrome (ARDS) and provide help for the prevention and treatment of this severe disease.@*Methods@#A retrospective analysis on the clinical data of 176 scrub typhus patients in the First Affiliated Hospital of Guangxi Medical University from 2009 to 2016 was conducted. The patients were divided into ARDS group (n=25) and non-ARDS group (n=151). Age, sex, the time from onset to diagnosis, clinical characteristics, laboratory examinations within 24 hours of admission, and acute physiology and chronic health evaluation (APACHE)Ⅱscore were recorded. The differences of clinical characteristics between two groups were compared, and the relevant factors were analyzed. Chi-square test, t-test, and Mann-Whitney U test were chosen for the comparison of categorical data and measurement data of normal or non-normal distribution, respectively, then statistically significant variables were included into logistic regression analysis.@*Results@#Fever (100.0%) was the most common clinical feature and elevated alanine aminotransferase (95.4%) was the most frequent laboratory abnormality. Age (t=3.055), APACHEⅡscore (t=5.592), D-dimer (t=2.704), the time from onset to diagnosis (t=5.719), serum level of creatinine (t=4.099), and the incidence of hepatosplenomegaly (χ2=5.202) in ARDS group were all higher than those in non-ARDS group (all P<0.05), while the platelet count, serum level of albumin in ARDS group were both lower than those in non-ARDS group (both P<0.05). Multiple factor logistic regression analysis demonstrated that age, APACHEⅡscore, D-dimer, the time from onset to diagnosis, and the platelet count were independent risk factors for scrub typhus complicated with ARDS. Fifteen patients died among the 176 cases, with eight (32%) in the ARDS group and seven (4.6%) in the non-ARDS group, the difference between the two groups was statistically significant (χ2=20.6, P<0.01).@*Conclusion@#Patients with scrub typhus should be definitely diagnosed at an early stage. Meanwhile, monitoring the risk factors of scrub typhus patients complicated with ARDS, and taking effective treatment can improve the prognosis of scrub typhus patients.