Severity Predictors in Eschar-Positive Scrub Typhus and Role of Serum Osteopontin

Sang-Won Park Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Chang-Seop Lee Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Chi Kug Lee Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Yee Gyung Kwak Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Chisook Moon Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Baek-Nam Kim Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Eu Suk Kim Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Jae Myung Kang Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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Myoung-don Oh Department of Internal Medicine, Seoul National University College of Medicine and Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea; Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea; Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea

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We prospectively evaluated severity predictors in terms of host, microorganism, and treatment factors in 153 eschar-positive scrub typhus patients. Severity was assessed with the Acute Physiology and Chronic Health Evaluation (APACHE) II score (< 10 versus ≥ 10) and predefined criteria of severe complications. Genotypes of Orientia tsutsugamushi were determined. Independent risk factors for severity (APACHE II score ≥ 10) were old age, diabetes mellitus, serum osteopontin > 100 ng/mL, and a group of underlying diseases (congestive heart failure, cerebrovascular disease, chronic liver disease, bronchial asthma, and chronic obstructive lung diseases). Anemia (≤ 10 g/dL) and C-reactive protein > 10 mg/dL were indicators of current severity. Neither the delay in antibiotics administration nor strain types (Boryong, Taguchi, or Kanda/Kawasaki) contributed to the severity. The risk factors for severe complications were similar. Serum osteopontin > 100 ng/mL had a negative predictive value of 96% for severe complications. This marker can be used to rule out severe disease status.

Author Notes

*Address correspondence to Chisook Moon, Department of Internal Medicine, Inje University College of Medicine, 633-165, Gaegeum-dong, Busanjin-gu, Busan 614-735, Republic of Korea. E-mail: duomon@hanmail.net

Financial support: This study was supported by grant 04-2009-610 from the Seoul National University Hospital (SNUH) Research Fund.

Authors' addresses: Sang-Won Park, Department of Internal Medicine, Boramae Medical Center, Seoul, Republic of Korea, E-mail: hswon1@snu.ac.kr. Chang-Seop Lee, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea, E-mail: lcsmd@chonbuk.ac.kr. Chi Kug Lee, Department of Internal Medicine, Namwon Medical Center, Namwon, Republic of Korea, E-mail: na25pro@hotmail.com. Yee Gyung Kwak, Chisook Moon, and Baek-Nam Kim, Department of Internal Medicine, Inje University College of Medicine, Busan, Republic of Korea, E-mails: philmed202@hanmail.net, duomon@hanmail.net, and griuni@chol.com. Eu Suk Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea, E-mail: yonathan@hanafos.com. Jae Myung Kang, Department of Internal Medicine, Handong Global University Sunlin Hospital, Pohang, Republic of Korea, E-mail: joshuakang@hanmail.net. Myoung-don Oh, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea, E-mail: mdohmd@snu.ac.kr.

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