Predictors of outcome in patients with diphtheria receiving intensive care

Forty eight patients with a clinical diagnosis of diphtheria, admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary care teaching hospital, from December 1994 to 2002, were analyzed retrospectively with respect to demographic details, clinical features, immunization status, complications and mortality. Several variables were compared among the survivors and non-survivors to define the predictors of outcome More than half 27 (56.3%). of the patients were unimmunized. Complications seen were: airway compromise 34 (70.8%), myocarditis 32 (66.6%), renal failure 17 (35.4%) and thrombocytopenia 15 (31.3%). Out of the 48 patients, 21 survived and 27 died (56.3%). The immediate cause of death was myocarditis 23 (85%), airway compromise 3 (11.1%) and septic shock due to nosocomial sepsis(1). Inadequate immunization, hypotension at admission and presence of any complication like airway compromise, myocarditis and renal failure had a significant (P <0.05) adverse effect on outcome; multiple regression analysis ascertained that, development of myocarditis was the only independent predictor of death (Adjusted OR 0.061; 95% CI 0.009-0.397; P = 0.003).