Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 1 ( 2018 ) > List of Articles

RESEARCH ARTICLE

Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with chikungunya

Desh Deepak, Anish Gupta, Suneel Garg

Keywords : Acute Physiology and Chronic Health Evaluation II score, chikungunya, sequential organ failure assessment score, viral tropism

Citation Information : Deepak D, Gupta A, Garg S. Clinical profile, intensive care unit course, and outcome of patients admitted in intensive care unit with chikungunya. Indian J Crit Care Med 2018; 22 (1):5-9.

DOI: 10.4103/ijccm.IJCCM_336_17

License: CC BY-ND 3.0

Published Online: 01-07-2008

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Objective: Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. Methods: All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated. Primary outcome measured was 28-day mortality and secondary outcomes measured were length of hospital and ICU stay and the need for vasopressor support, renal replacement therapy (RRT), and mechanical ventilation (MV). Logistic regression analysis was performed to identify factors predicting mortality. Results: The most common complaints were fever (96.67%) and altered sensorium (56.67%). Mean admission APACHE II and SOFA scores were 17.28 ± 7.9 and 7.15 ± 4.2, respectively. Fifty-one patients had underlying comorbidities. Vasopressors were required by 46.76%; RRT by 26.67%, and MV by 58.33%, respectively. The 28-day mortality was 36.67%. High APACHE II score (odds ratio: 1.535; 95% confidence interval: 1.053–2.237; P = 0.026) and need for dialysis (odds ratio: 833.221; 95% confidence interval: 1.853–374,664.825; P = 0.031) could independently predict mortality. Conclusions: Patients with chikungunya fever may require ICU admission for organ failure. They are generally elderly patients with underlying comorbidities. Despite aggressive resuscitation and organ support, these patients are at high risk of death. Admission APACHE II score and need for dialysis may predict patients at higher risk of death.


PDF Share
  1. Nsoesie EO, Kraemer MU, Golding N, Pigott DM, Brady OJ, Moyes CL, et al. Global distribution and environmental suitability for chikungunya virus, 1952 to 2015. Euro Surveill 2016;21.
  2. Crosby L, Perreau C, Madeux B, Cossic J, Armand C, Herrmann-Storke C, et al. Severe manifestations of chikungunya virus in critically ill patients during the 2013-2014 Caribbean outbreak. Int J Infect Dis 2016;48:78-80.
  3. Lemant J, Boisson V, Winer A, Thibault L, André H, Tixier F, et al. Serious acute chikungunya virus infection requiring intensive care during the Reunion Island outbreak in 2005-2006. Crit Care Med 2008;36:2536-41.
  4. Economopoulou A, Dominguez M, Helynck B, Sissoko D, Wichmann O, Quenel P, et al. Atypical Chikungunya virus infections: Clinical manifestations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Réunion. Epidemiol Infect 2009;137:534-41.
  5. Robinson MC. An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-53. I. Clinical features. Trans R Soc Trop Med Hyg 1955;49:28-32.
  6. Shah KV, Gibbs CJ Jr., Banerjee G. Virological investigation of the epidemic of haemorrhagic fever in Calcutta: Isolation of three strains of Chikungunya virus. Indian J Med Res 1964;52:676-83.
  7. Azami NA, Salleh SA, Shah SA, Neoh HM, Othman Z, Zakaria SZ, et al. Emergence of chikungunya seropositivity in healthy Malaysian adults residing in outbreak-free locations: Chikungunya seroprevalence results from the Malaysian cohort. BMC Infect Dis 2013;13:67.
  8. Pulmanausahakul R, Roytrakul S, Auewarakul P, Smith DR. Chikungunya in Southeast Asia: Understanding the emergence and finding solutions. Int J Infect Dis 2011;15:e671-6.
  9. Mavalankar D, Shastri P, Bandyopadhyay T, Parmar J, Ramani KV. Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India. Emerg Infect Dis 2008;14:412-5.
  10. Rajapakse S, Rodrigo C, Rajapakse A. Atypical manifestations of chikungunya infection. Trans R Soc Trop Med Hyg 2010;104:89-96.
  11. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  12. 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 Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
  13. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10.
  14. Centers for Disease Control and Prevention. Atlanta: Chikungunya Virus. Available from: https://www.cdc.gov/chikungunya/hc/clinicalevaluation.html. [Last accessed on 2017 Dec 31].
  15. Torres JR, Leopoldo Códova G, Castro JS, Rodríguez L, Saravia V, Arvelaez J, et al. Chikungunya fever: Atypical and lethal cases in the Western hemisphere: A Venezuelan experience. IDCases 2015;2:6-10.
  16. Hoz JM, Bayona B, Viloria S, Accini JL, Juan-Vergara HS, Viasus D, et al. Fatal cases of Chikungunya virus infection in Colombia: Diagnostic and treatment challenges. J Clin Virol 2015;69:27-9.
  17. Al Nsour M, Kaiser R, Abd Elkreem E, Walke H, Kandeel A, Bloland R, et al. Highlights and conclusions from the Eastern Mediterranean Public Health Network (EMPHNET) conference 2011. East Mediterr Health J 2012;18:189-91.
  18. Pellot AS, Alessandri JL, Robin S, Sampériz S, Attali T, Brayer C, et al. Severe forms of chikungunya virus infection in a pediatric Intensive Care Unit on Reunion Island. Med Trop (Mars) 2012;72:88-93.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.