Elevated procalcitonin is associated with increased mortality in patients with scrub typhus infection needing intensive care admission
Year: 2013
Type: article
Study design: Observational Study
Abstract: and can be associated with multi-organ dysfunction.[4] Procalcitonin is a biomarker frequently used in bacterial sepsis.[5] It is unclear if this biomarker is elevated in rickettsial illnesses, particularly in scrub typhus.The aim of the study was to assess if procalcitonin is elevated in severe scrub typhus infection and whether higher levels portend a poorer prognosis. Materials and MethodsIn this retrospective study, consecutive patients admitted to the medical intensive care unit (ICU) with a diagnosis of scrub typhus infection with organ dysfunction [6] between August 2008 and April 2010 who also had procalcitonin levels assessed Context: Procalcitonin is a biomarker of bacterial sepsis.It is unclear if scrub typhus, a rickettsial illness, is associated with elevated procalcitonin levels.Aim: To assess if scrub typhus infection is associated with high procalcitonin levels and whether high levels portend a poorer prognosis.Setting and Design: Retrospective study of patients with severe scrub typhus infection, admitted to the medical intensive care unit of a tertiary care university affiliated teaching hospital.Materials and Methods: Eighty-four patients with severe scrub typhus infection that also had procalcitonin levels were assessed.Statistical Analysis: Relationship between procalcitonin and mortality explored using univariate and multivariate analyses.Results: The mean (±standard deviation) age was 40.0 ± 15.5 years.Patients were symptomatic for 8.3 ± 4.3 days prior to presentation.The median admission procalcitonin level was 4.0 (interquartile range 1.8 to 8.5) ng/ml; 59 (70.2%) patients had levels >2 ng/ml.Invasive mechanical ventilation was required in 65 patients; 20 patients died.On univariate analysis, admission procalcitonin was associated with increased odds of death [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03 to 1.18].On multivariate logistic regression analysis including procalcitonin and APACHE-II score, the APACHE-II score was significantly associated with mortality (OR 1.16, 95% CI 1.06 to 1.30, P = 0.004) while a trend was observed with procalcitonin (OR 1.05, 95%CI 1.01 to 1.13, P = 0.09).The area under the receiver operating characteristic (ROC) curve, AUC, for mortality was 0.77 for procalcitonin and 0.78 for APACHE-II.Conclusions: Procalcitonin is elevated in severe scrub typhus infection and may be associated with higher mortality.
Authors: Binila Chacko, John Victor Peter, Gunasekaran Karthik, Kartik Ramakrishna, Mathew F. Griffith, John Antony Jude Prakash, Victoria Job, Petra L. Graham
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1964277374