Karthik Kumar, P (2020) Study of Aetiology and Outcome in Acute Febrile Illness Patients with Multiple Organ Dysfunction Syndrome. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Infectious diseases, especially gram negative organisms are the commonest causes of MODS followed by poly trauma. The pathogenesis of MODS is incompletely under-stood but hypothesized to result from a combination of impaired inflammatory response and immune dysfunction, maldistribution of microcirculatory blood flow and or ischemic-reperfusion injury. This contributes to sequential involvement of various organs with mortality rate ranging from of 27%-100% depending on the number of organs involved. Several scoring systems have been described to diagnose and quantify these organ dysfunctions. The present study was undertaken to study the aetiology and outcome of acute febrile illness patients developing MODS. AIM OF THE STUDY: 1. To study the aetiology of acute febrile illness in patients developing MODS. 2. To study the final outcome among these patients. OBJECTIVES: 1. To study the aetiology and outcome among patients with acute febrile illness developing MODS in medical intensive care unit. 2. To determine the prognosis as it was inversely dependent on the number of organs involved especially with CNS manifestations. MATERIALS AND METHODS: STUDY SETTING: Patient who are admitted in the intensive medical care unit in the Department of Internal Medicine, Government Stanley Medical College and Hospital, Chennai. STUDY POPULATION: Patients with acute febrile illness with two or more organ dysfunction without preexisting comorbid conditions. STUDY DESIGN: Prospective observational study. POPULATION STUDIED: 75. DURATION OF THE STUDY: 1 year (Oct 2017 to Oct 2018). Inclusion criteria: 1. Patient in critical care setting, 2. Documented or history of fever, 3. Dysfunction and/or failure of two or more organs, 4. Organ dysfunction persisting for more than 24 hours. Exclusion criteria: 1. Pregnancy 2. Associated with less than two organ dysfunction, 3. Organ dysfunction lasting less than 24 hours, 4. Chronic illness like diabetes, malignancies, ischemic heart disease etc. 5. Postoperative, posttraumatic or any surgical cases, 6. Not able to give informed consent. RESULTS From the study it was noted that the age group incidence is more with 29-38 years of age which is of about 48 %. The peak incidence of mortality of 65% was in the age group of 29-38 years. Among 75 patients the study, 46 were males (61.3 %) and 29 (38.7 %) were females. There was no significant difference statistically in relation to gender status. Majority were males (61.3%).In relation to the total leucocyte count the mortality was high 10(50%) in 4000-10000 group followed by 9(45%) in WBC count of more than 10000 group. The platelet count was less than 1.5 lakhs in 57(76.0%) of the population and it was around more than 1.5 lakhs in 18(24.0%) of the study. Population, suggesting prevalence of more number of cases with thrombocytopenia in the study group and finally it was found that the mortality was higher 16 (80.0%) among the patients with thrombocytopenia group that is platelets with less than 1.5 lakhs., hence depicting the poor outcome when compared to those population with platelet count ofmore than 1.5 lakhs. The serum creatinine level was less than 1.2 in 32(42.7%) of the population and it was more than 1.2 in 43(57.3%) of the study. Population, suggesting derangement of renal function in more than half of the study population and it was found that the mortality was higher 11 (55%) among the patients with serum creatinine level more than 1.2, hence patients with acute kidney injury had poor outcome when compared to patients with no renal involvement. CONCLUSION: Aetiology of acute febrile illness can be influenced by regional and seasonal trends. The sizeable proportion of these cases remains undiagnosed with high mortality when compared to patients with established aetiology. Overall, early involvement of lungs, kidney and haematopoietic system portends bad prognosis in the setting of multiorgan dysfunction. Central nervous system involvement could be an independent clinical predictor of poor prognosis. There is an urgent need of developing standard protocol and cost effective additional serological markers to evaluate undiagnosed cases of acute febrile illness for early diagnosis and prognostication.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201711056 |
| Uncontrolled Keywords: | Aetiology and Outcome, Acute Febrile Illness Patients, Multiple Organ Dysfunction Syndrome. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 28 Jan 2021 12:35 |
| Last Modified: | 28 Jan 2021 12:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13227 |
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