Predictors of Mortality in Acute Febrile Illness: A Prospective Observational Study at a Tertiary Care Center in South Gujarat

Background: Acute febrile illness (AFI) is a major public health problem in tropical regions such as South Gujarat, India, contributing to significant morbidity and mortality due to diverse viral, bacterial, and parasitic etiologies. Early identification of mortality predictors is essential, especially in resource-limited tertiary care settings. Although studies from other parts of India report factors like low Glasgow Coma Scale, renal dysfunction, and undiagnosed illness, regional data from South Gujarat are scarce. This prospective observational study evaluated clinical, laboratory, and etiological predictors of mortality in AFI patients over one year. Material and Methods: Conducted over a year, this study enrolled 300 adult patients (aged ≥18 years) presenting with fever >38°C lasting 3-14 days without an obvious focus of infection. Ethical approval was obtained from the institutional review board, and informed consent was secured. Patients with known chronic illnesses exacerbating fever or those refusing participation were excluded. Data collection included demographics, clinical history, physical examination, routine blood tests, serological assays for dengue, malaria, scrub typhus, leptospirosis, and enteric fever, plus imaging and cultures as needed. Statistical analysis used SPSS software; univariate comparisons employed chi-square and t-tests, while multivariate logistic regression identified independent predictors (p<0.05 significant). Results: Of 300 patients, 176 (58.7%) were male, mean age 42.3 ± 15.6 years. Common etiologies: dengue (32.3%), scrub typhus (28.7%), malaria (12.0%), bacterial sepsis (8.3%), leptospirosis (4.7%), enteric fever (3.3%), undiagnosed (10.7%). Mortality rate was 8.0% (24 deaths). Non-survivors had significantly lower GCS (mean 8.2 vs. 13.4, p<0.001), higher creatinine (2.8 vs. 1.1 mg/dL, p<0.001), and more frequent shock (45.8% vs. 12.3%, p<0.001). Multivariate analysis revealed independent predictors: GCS <9 (OR 4.2, 95% CI 2.1-8.4), elevated creatinine >2 mg/dL (OR 3.1, 95% CI 1.5-6.3), age >60 years (OR 2.8, 95% CI 1.3-5.9), and undiagnosed etiology (OR 5.6, 95% CI 2.7-11.4).