Predictors of 28-day mortality in melioidosis patients presenting to an emergency department: a retrospective cohort study from South India

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 118; no. 10; pp. 652 - 658
• Main Authors: Nisarg, S, Tirlangi, Praveen Kumar, Ravindra, Prithvishree, Bhat, Rachana, Sujir, Sachin Nayak, Alli, Sai Deepak, Chowdhury, Soumi, Earny, Venkat Abhiram, Gupta, Nitin, Mukhopadhyay, Chiranjay
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.10.2024
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Azithromycin - therapeutic use; Emergency Service, Hospital - statistics & numerical data; Female; Humans; India - epidemiology; Logistic Models; Male; Melioidosis - drug therapy; Melioidosis - mortality; Middle Aged; Piperacillin, Tazobactam Drug Combination - therapeutic use; Retrospective Studies; Risk Factors; Vasoconstrictor Agents - therapeutic use; India; meropenem; septic shock; ceftazidime; community-acquired pneumonia; sepsis; Burkholderia pseudomallei
• ISSN: 0035-9203; 1878-3503; 1878-3503
• DOI: 10.1093/trstmh/trae017

Abstract Background Septic melioidosis is associated with high mortality in resource-limited settings. The current study aims to find 28-d all-cause mortality predictors within 24 h of admission in melioidosis patients presenting to an emergency department. Methods This retrospective cohort study (2018–2022) included melioidosis patients divided into two groups based on their primary outcomes (28-d mortality). All the clinically relevant factors significant in univariate analysis were selected for binary logistic regression analysis. Those factors significant in logistic regression analysis were considered independent predictors of mortality. Results Of the 53 patients with melioidosis, the 28-d mortality of melioidosis patients admitted to the emergency department was 51% (n=27). Respiratory involvement, renal dysfunction, haemodynamic instability, elevated aspartate transaminase, elevated activated partial thromboplastin time, elevated CRP, elevated procalcitonin, decreased albumin, decreased absolute neutrophil count, decreased absolute lymphocyte count and use of piperacillin-tazobactam or azithromycin were significant predictors of mortality on univariate analysis. Vasopressor requirement (p=0.03) and low serum albumin level (0.041) at presentation were independent predictors of mortality. Conclusion Vasopressor requirement and low albumin levels at presentation in the emergency department are independent predictors of mortality. There is a need to create awareness among primary care physicians to enable early diagnosis and prompt initiation of treatment.