Fever, thrombocytopenia, and AKI-A profile of malaria, dengue, and leptospirosis with renal failure in a South Indian tertiary-care hospital
2016
Introduction: In the tropics, the
triad of fever, thrombocytopenia, and AKI
portends a grim prognosis with high mortality
and a severe strain on already-stretched
resources. Malaria, dengue, and leptospirosis
account for most cases. We undertook
a review of cases to determine factors accounting
for adverse prognosis. Methods:
All patients presenting to the emergency
room (ER) with a history of fever, thrombocytopenia,
and renal failure were included
in the study. Patients were followed until
discharge or death, and end points looked at
were 1-week and 30-day mortality, and renal
function upon discharge. Parameters like
liver function test (LFT), renal function, and
platelet count upon discharge were also documented.
Results: A total of 43 patients was
included in the study. Mean age was 42.5
years with 86% males. Mean APACHE and
SOFA scores on admission were 23.89 and
15.42, respectively. Mean admission platelet
counts were 41,000. Mean serum creatinine
was 4.1, and bilirubin was 9.94. A platelet
count of 4,
albumin of > 2.3, SOFA score of > 20, and
APACHE score of > 32.2 were significantly
predictive of 1 week mortality. Need for mechanical
ventilation, oliguria on admission,
and need for dialysis all were highly predictive
of 30-day mortality. In addition, a serum
bicarbonate of 1.5, hemoglobin
of < 9.5 were highly predictive of higher
30 day mortality. Overall, 1-week mortality
was 16.3%, of which 48% was accounted for
by patients with leptospirosis. Conclusions:
Factors like low platelet count, oliguria, need
for dialysis, high APACHE and SOFA scores
on admission, need for mechanical ventilation,
and low serum albumin portend a grave
prognosis. There is need for randomized control
trials (RCT) to further determine adverse
prognostic factors in this subsect of patients.
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