Clinical predictors of multiple organ dysfunction syndromes in pediatric patients with scrub typhus

Abstract

Scrub typhus can produce multiple organ dysfunction syndrome (MODS). Early recognition of the patients at risk of MODS would be helpful in providing timely management and reducing the mortality. In all, 449 children with scrub typhus were enrolled at three hospitals in Yunnan, China from January 2010 to January 2015. The patients' clinical status of organ system dysfunction was evaluated on the day of discharge from hospital by using standard criteria. The patients were classified into MODS present (64 cases, 14.3%) or MODS absent (385 cases, 85.7%). Multivariate logistic regression analyses revealed that the prognostic factors for MODS included skin rash (odds ratio, OR=3.3, p=0.037), time interval form treatment to defervescence (OR=1.2, p=0.035), hemoglobin (OR=0.54, p=0.041), platelet counts (OR=0.06, p<0.001), aspartate-aminotransferase (OR=4.7, p=0.011) and total bilirubin (OR=2.3, p=0.013). By describing risk factors resulting in MODS in pediatric scrub typhus, our study provides clinicians with important information to improve the clinical monitoring and prognostication of MODS.