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Clinical risk-scoring algorithm to forecast scrub typhus severity.
[scrub typhus]
To
develop
a
simple
risk-scoring
system
to
forecast
scrub
typhus
severity
.
Seven
years
'
retrospective
data
of
patients
diagnosed
with
scrub
typhus
from
two
university-affiliated
hospitals
in
the
north
of
Thailand
were
analyzed
.
Patients
were
categorized
into
three
severity
groups
:
nonsevere
,
severe
,
and
dead
.
Predictors
for
severity
were
analyzed
under
multivariable
ordinal
continuation
ratio
logistic
regression
.
Significant
coefficients
were
transformed
into
item
score
and
summed
to
total
scores
.
Predictors
of
scrub
typhus
severity
were
age
>
15
years
,
(
odds
ratio
[
OR
]
=
4
.
09
)
,
pulse
rate
>
100
/
minute
(
OR
3
.
19
)
,
crepitation
(
OR
2
.
97
)
,
serum
aspartate
aminotransferase
>
160
IU
/
L
(
OR
2
.
89
)
,
serum
albumin
≤
3
.
0
g
/
dL
(
OR
4
.
69
)
,
and
serum
creatinine
>
1
.
4
mg
/
dL
(
OR
8
.
19
)
.
The
scores
which
ranged
from
0
to
16
,
classified
patients
into
three
risk
levels
:
non-
severe
(
score
≤
5
,
n
=
278
,
52
.
8
%
)
,
severe
(
score
6
-
9
,
n
=
143
,
27
.
2
%
)
,
and
fatal
(
score
≥
10
,
n
=
105
,
20
.
0
%
)
.
Exact
severity
classification
was
obtained
in
68
.
3
%
of
cases
.
Underestimations
of
5
.
9
%
and
overestimations
of
25
.
8
%
were
clinically
acceptable
.
The
derived
scrub
typhus
severity
score
classified
patients
into
their
severity
levels
with
high
levels
of
prediction
,
with
clinically
acceptable
under-
and
overestimations
.
This
classification
may
assist
clinicians
in
patient
prognostication
,
investigation
,
and
management
.
The
scoring
algorithm
should
be
validated
by
independent
data
before
adoption
into
routine
clinical
practice
.
Diseases
Validation
Diseases presenting
"routine clinical practice"
symptom
adrenal incidentaloma
congenital adrenal hyperplasia
cystinuria
scrub typhus
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