The Association of Lipid Abnormalities with Complications in Severe Scrub Typhus

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

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.

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).

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.