1475. Etiology and Outcome of Fever and Respiratory Distress in Adult Patients Presenting to Medical Emergency in a Tertiary Care Hospital in North India

Abstract

BackgroundTo study the region-specific etiology and outcome in adult patients with acute febrile illness and ARDSMethodsProspective observational study done among 102 adult patients admitted to medical emergency, PGIMER, during study interval of 18 months (January 2016 to June 2017), with acute febrile illness (oral temperature more 101°F for less than 14 days with no localising symptoms) and ARDS(acute onset respiratory distress within one week of fever or new/worsening respiratory symptoms with bilateral opacities on chest radiograph, symptoms not explained by cardiac failure or fluid overload with PaO2/FiO2 ratio <300 with PEEP or CPAP >5 cm H2O).All patients were investigated for the etiology as per standard protocol for malaria, scrub typhus, Leptospira, enteric fever, dengue, H1N1 influenza. Patients were followed till discharge or 28th day whichever is longerResultsAmong the 102 patients recruited in the study, 41.2% were males and 58.8% were females. Mean age of presentation was 38.06+/−17.26 years. 46% of patients admitted during post monsoon season. 26.5% patients had succumbed to their illness. Cough (61.8%), hepatomegaly (50%), myalgia (50%), splenomegaly (30.3%), pedal edema (31.4%), pallor (39.4%), vomiting (26.7%) were most common findings apart from fever and dyspnoea. Nine of them had bleeding manifestations. The most common diagnosis was Scrub typhus (32.4%), followed by coinfections (13.7%), H1N1 influenza in 8.8% cases. 30.4% patients did not fall into any diagnostic criteria. Leptospira, dengue and Malaria were present in 4.4 and 2 cases, respectively. A total of 50 patients were intubated and ventilated during their stay in the hospital. APACHE 2 score was observed to better predict mortality than SOFA score. Factors which predicted mortality were male sex, age >45 years, invasive ventilation and low GCSConclusionFever and ARDS have more incidence among young females and occur significantly during post monsoon season. Scrub typhus constituted the majority of fever with ARDS cases followed by H1N1. Coinfections were common cause of Fever with ARDS. Predictors of mortality were male gender, old age, long duration of invasive ventilation, higher serum procalcitonin levels and low GCS at admission. APACHE 2 score was a better predictor of mortality than SOFA score.Disclosures All authors: No reported disclosures.