Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions
Acute Physiology and Chronic Health Evaluation II, organ dysfunction, quick sequential organ failure assessment, scrub typhus, sequential organ failure assessment
Citation Information :
Kumar S, Balasubramanian P, Sharma N. Critical illness scoring systems: Sequential organ failure assessment, Acute Physiology and Chronic Health Evaluation II, and quick sequential organ failure assessment to predict the clinical outcomes in scrub typhus patients with organ dysfunctions. Indian J Crit Care Med 2018; 22 (10):706-710.
Background and Aim: Scrub typhus (ST) is an acute infectious disease of variable severity caused by Orientia (formerly Rickettsia) tsutsugamushi. The disease can be complicated by organ dysfunctions and the case fatality rate (CFR) is approximately 15%, which further rises with the development of severe complications. We studied the clinical features of the ST and the performance of critical illness scoring systems (CISSs) – Acute Physiology and Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) in predicting the clinical outcomes in complicated ST (cST) patients admitted to the emergency department.
Study Design and Methods: A prospective observational study was done in 50 patients diagnosed to have cST with one or more organ dysfunctions. Clinical features and laboratory parameters were recorded and the patients were followed up until the end of their stay in the hospital. APACHE II, SOFA, and qSOFA scores at admission were calculated and were analyzed in predicting the clinical outcomes.
Results: The median SOFA, APACHE II, and qSOFA scores of the cohort were 7 (interquartile range [IQR] = 13–22), 8 (IQR = 5–11), and 2 (IQR = 1–3), respectively. The median duration of in-hospital stay was 9 (IQR 5–11) days and overall CFR was 8%. On bivariate analysis, both SOFA (P = 0.031) and qSOFA (P = 0.001) predicted mortality. However, only SOFA score correlated with the in-hospital stay duration (Pearson's correlation = 0.311, P = 0.028).
Conclusion: Among the three CISSs studied, the SOFA score correlated with in-hospital stay duration and mortality, whereas the qSOFA score formed a simple as well as a convenient tool in predicting the mortality in patients of cST with organ dysfunction.
Watt G. Scrub typhus. In: Warrell DA, Cox TM, Firth JD, editors. Oxford Textbook of Medicine. 5th ed. USA: Oxford University Press; 2010. p. 919-24.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:762-74.
Griffith M, Peter JV, Karthik G, Ramakrishna K, Prakash JA, Kalki RC, et al. Profile of organ dysfunction and predictors of mortality in severe scrub typhus infection requiring intensive care admission. Indian J Crit Care Med 2014;18:497-502.
Furuya Y, Yoshida Y, Katayama T, Yamamoto S, Kawamura A Jr. Serotype-specific amplification of Rickettsia tsutsugamushi DNA by nested polymerase chain reaction. J Clin Microbiol 1993;31:1637-40.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: The Berlin definition. JAMA 2012;307:2526-33.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120:c179-84.
Sekhon SS, Roy V. Thrombocytopenia in adults: A practical approach to evaluation and management. South Med J 2006;99:491-8.
Polson J, Lee WM, American Association for the Study of Liver Disease. AASLD position paper: The management of acute liver failure. Hepatology 2005;41:1179-97.
Sharma S, Mishra D, Aneja S, Kumar R, Jain A, Vashishtha VM, et al. Consensus guidelines on evaluation and management of suspected acute viral encephalitis in children in India. Indian Pediatr 2012;49:897-910.
Moron CG, Popov VL, Feng HM, Wear D, Walker DH. Identification of the target cells of Orientia tsutsugamushi in human cases of scrub typhus. Mod Pathol 2001;14:752-9.
Sharma N, Biswal M, Kumar A, Zaman K, Jain S, Bhalla A, et al. Scrub typhus in a tertiary care hospital in North India. Am J Trop Med Hyg 2016;95:447-51.
Sinha P, Gupta S, Dawra R, Rijhawan P. Recent outbreak of scrub typhus in north western part of India. Indian J Med Microbiol 2014;32:247-50.
Varghese GM, Trowbridge P, Janardhanan J, Thomas K, Peter JV, Mathews P, et al. Clinical profile and improving mortality trend of scrub typhus in South India. Int J Infect Dis 2014;23:39-43.
Narvencar KP, Rodrigues S, Nevrekar RP, Dias L, Dias A, Vaz M, et al. Scrub typhus in patients reporting with acute febrile illness at a tertiary health care institution in Goa. Indian J Med Res 2012;136:1020-4.
Vivekanandan M, Mani A, Priya YS, Singh AP, Jayakumar S, Purty S, et al. Outbreak of scrub typhus in Pondicherry. J Assoc Physicians India 2010;58:24-8.
Park JH, Kim SJ, Youn SK, Park K, Gwack J. Epidemiology of scrub typhus and the eschars patterns in South Korea from 2008 to 2012. Jpn J Infect Dis 2014;67:458-63.
Wang YC, Chen PC, Lee KF, Wu YC, Chiu CH. Scrub typhus cases in a teaching hospital in Penghu, Taiwan, 2006-2010. Vector Borne Zoonotic Dis 2013;13:154-9.
Hamaguchi S, Cuong NC, Tra DT, Doan YH, Shimizu K, Tuan NQ, et al. Clinical and epidemiological characteristics of scrub typhus and murine typhus among hospitalized patients with acute undifferentiated fever in Northern Vietnam. Am J Trop Med Hyg 2015;92:972-8.
Zhang M, Zhao ZT, Wang XJ, Li Z, Ding L, Ding SJ, et al. Scrub typhus: Surveillance, clinical profile and diagnostic issues in Shandong, China. Am J Trop Med Hyg 2012;87:1099-104.
Thipmontree W, Tantibhedhyangkul W, Silpasakorn S, Wongsawat E, Waywa D, Suputtamongkol Y, et al. Scrub typhus in Northeastern Thailand: Eschar distribution, abnormal electrocardiographic findings, and predictors of fatal outcome. Am J Trop Med Hyg 2016;95:769-73.
Kumar V, Kumar V, Yadav AK, Iyengar S, Bhalla A, Sharma N, et al. Scrub typhus is an under-recognized cause of acute febrile illness with acute kidney injury in India. PLoS Negl Trop Dis 2014;8:e2605.