The Association of Lipid Abnormalities with Complications in Severe Scrub Typhus.

Abstract

Aim: To study abnormalities of lipids in patients suffering from severe scrub typhus and their relationship with complications.

Methods: This cohort study was conducted in patients of severe scrub typhus [immunoglobulin (IgM) positive by enzyme-linked immunosorbent assay (ELISA)] admitted to our institute from 1^st August 2020 through 31^st July 2021. The lipid profile was estimated initially at the time of hospitalization. Serum total cholesterol, serum triglyceride levels (TGs), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were estimated. The association (risk ratios) of lipids abnormalities was determined with mortality, multiple organ dysfunction syndrome (MODS), septic shock, and septic shock with MODS.

Results: We studied 100 patients (mean age of 48.4 ± 16.3 years) of whom 73 (73%) were females. On presentation, fever (91%), myalgias (38%), abdominal pain (16%), shortness of breath (15%), and cough (12%) were main symptoms. On examination, tachypnoea (68%), tachycardia (65%), conjunctival suffusion (37%), icterus (29%), eschar (14%), abdominal tenderness (10%), splenomegaly (4%), and hepatomegaly (3%) were noted. In lipid abnormalities, 93 (93%) patients had low HDL-C (males <40 mg/dL, females <50 mg/dL), serum triglycerides (200 mg/dL) were elevated in 71 (71%) patients, serum total cholesterol (>240 mg/dL) was increased in 4 (4%) patients, and 4 patients had raised serum LDL-C levels (160-189 mg/dL). Sixty-two (62%) patients developed MODS, 16 (16%) had septic shock, 15 (15%) developed septic shock with MODS, and 4 (4%) patients died. High serum TGs (>200 mg/dL) were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, p = 0.008) and septic shock with MODS (RR = 4.2, 95% CI = 1-17.4, p = 0.022) and the serum LDL-C levels <50 mg/dL were associated with MODS (RR = 1.6, 95% CI = 1.2-2.0, p = 0.007).

Conclusion: There was a significant association of increased severity of scrub typhus with high TGs (>200 mg/dL) levels and low levels of LDL-C (<50 mg/dL) in admitted patients of severe scrub typhus.