Predictors Of Multiple Organ Dysfunction Syndrome Research Articles

Clinical and paraclinical profile, and predictors of outcome in 90 cases of scrub typhus, Meghalaya, India.

BackgroundIndia is an integral component of “tsutsugamushi triangle” which depicts a part of the globe endemic to scrub typhus. Owing to frequent outbreaks witnessed in different parts of the country in the recent past, scrub typhus is described as a re-emerging infectious disease in India. The present study aimed to study the clinical and paraclinical profile, complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012.MethodsA longitudinal study was conducted in a hospital of Meghalaya, India between Sept 2011 and Aug 2012. Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi (solid phase immunochromatographic assay) rapid diagnostic test for antibodies (IgM, IgG or IgA). Descriptive analyses of age, gender, geographic area, symptoms and signs, treatment, laboratory findings, complications, and outcome were conducted. Relative risk (RR) with 95 % confidence interval (CI) was computed for Multiple Organ Dysfunction Syndrome (MODS) and mortality. Binary logistic regression was applied to the significant correlates (P < 0.05) on univariate analysis to identify the predictors of MODS and mortality in scrub typhus.ResultsAs many as 662 clinically suspected scrub typhus patients were tested and 90 (13.6 %) were diagnosed to have scrub typhus. Out of 90 patients, 52.2 % (n = 47) were males and their mean (SD) age was 36.29 (13.38) years. Fever of <7 days (n = 75, 83.3 %), myalgia (n = 56, 62.2 %), pain abdomen (n = 24, 26.7 %), headache (n = 24, 26.7 %), nausea/vomiting (n = 21, 23.3 %), dry cough (n = 21, 23.3 %), hepatomegaly (n = 24, 26.7 %), splenomegaly (n = 22, 24.4 %), and lymphadenopathy (n = 20, 22.2 %) were the predominant clinical features. Eschar was seen in 10 patients (11.1 %). One third (n = 30) of the patients developed at least one systemic complication. Acute hepatitis (n = 15, 16.7 %), pneumonitis (n = 14, 15.6 %), and acute kidney injury (n = 11, 12.2 %) were the common complications. MODS was seen in 14.4 % (n = 13) and 38.5 % (n = 5) of the patients with MODS died. Overall, case fatality rate was 5.15 % (n = 5). On univariate analysis, platelets <100 000/mm3, serum creatinine >1.5 mg/dl, and transaminase (AST, ALT or both) >500 U/L were associated with MODS (P < 0.001) and mortality (P < 0.05). In addition, serum bilirubin >3 mg/dl was also associated with MODS (P < 0.001). On applying binary logistic regression, serum creatinine >1.5 mg/dl was a predictor of MODS (OR: 76.1, 95 % CI: 4.9–1175.6) and mortality (OR: 18.03, 95 % CI: 1.38–235.1).ConclusionIn this study setting, approximately one-seventh (13.6 %) of the acute undifferentiated febrile illness were due to scrub typhus. Systemic complications were common (33.3 %). Serum creatinine >1.5 mg/dl was a predictor of MODS and mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0186-x) contains supplementary material, which is available to authorized users.

The value of PCT, CRP, TNF-α and free DNA in predicting the development of MODS in patients with multiple trauma

Objective To explore the value of peripheral blood serum levels of PCT,CRP,TNF-α and free DNA of cells in predicting the development of MODS in patients with multiple trauma.Methods Complete detail clinical data of 54 casualties with multiple trauma admitted within 24 hours after accident from January 2011 through January 2012 were collected for retrospective study.The patients were divided into MODS group and non-MODS group according the criteria set forth by the Chinese Society of Critical Care and Emergency Medicine in 1995 national conference.The data of two groups are comparable,and data of another 20 healthy subjects undertaking routine annual physical examination were taken as control.The peripheral blood levels of PCT,CRP,TNF-α and free DNA of patients of two groups were determined 1 d,2 d,3 d,and 5 days after admission.Then the results were analyzed and compared between groups.Results Compared with non MODS group,the levels of PCT,CRP,free DNA of cells in MODS group were significantly higher (P ＜ 0.05),but there was no deference in TNF-α between MODS group and non-MODS group (P ＞ 0.05).When the relative risks of increased PCT (PCT≥6 mg/L),increased CRP (CRP≥ 130 mg/L)、and increased free DNA of cells (free DNA ≥ 10 0005/L) were analyzed,the presence of these 3 biomarkers with high levels occurred at the same time was the most accurate way to predicts MODS in 6.00 relative risk (RR),and the positive predictive value was 100％.Conclusions PCT,CRP,free DNA of cells could be the predictors of MODS in patients with severe multiple trauma,and the presence of high levels of these three biomarkers appearing together had high sensitivity and specificity for prediction. Key words: Multiple trauma; Procalcitonin (PCT) ; C-reactive protein (CRP) ; Tumor necrosis factor (TNF-α); Cell free DNA; Multiple organ dysfunction syndrome (MODS); Predictive value; Statistically significant

Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients

Purpose: To determine whether measuring heart rate variability (HRV) in a group of septic patients without multiple organ dysfunction syndrome (MODS) made it possible to predict which of them would later develop this syndrome. Material and Methods: We studied 46 septic patients without MODS at the time of admission to an intensive care unit (ICU). During the first 24 hours of admission, a 10-minute electrocardiogram (ECG) was performed and 8 HRV indexes were calculated off-line. Eleven patients later developed MODS (MODS group) during their ICU stay, and 28 did not (non-MODS group). Seven patients were excluded. Results: Although Acute Physiological and Chronic Health Evaluation (APACHE II) scores were similar for both groups, most HRV indices on admission were reduced significantly in the MODS group. Compared with a subset from the non-MODS group (control group, n = 11) paired by age, the MODS group had significantly lower low-frequency spectral components (LF, P = .0128) and mean squared successive differences of R-R intervals (rMSSD) ( P = .0473) values. Multivariable logistic regression identified LF as the best predictor of MODS and received operating characteristic (ROC) curves established its cut-off point at 18 ms 2. Mortality rates were 63.6% for the MODS group and 0% for the non-MODS group ( P < .0001). Conclusions: Reduction of HRV on ICU admission may be useful in identifying septic patients at risk for development of MODS.