Prognosis

Mortality ranging from 30% to 85% has been reported for streptococcal toxic shock syndrome (TSS), despite prompt antibiotic therapy.​​​[33][34][41][46][47][63][99][115][116]​​​ Death is usually due to cardiac arrhythmias, cardiomyopathy, and respiratory failure.[117][118]​​ Higher mortality is associated with necrotising fasciitis and TSS.[63] Shock is the most important predictor of death.[119] Advanced age, hypotension, and multi-organ system failure are significantly associated with increased mortality.[120]

Menstrual staphylococcal TSS has a mortality of approximately 8%.[19]​ One study in the US found a higher mortality rate in non-menstrual TSS compared with menstrual TSS.[21] However, a study in the UK reported no difference in mortality between menstrual and non-menstrual TSS.[20] Mortality may be higher in staphylococcal TSS associated with toxins other than toxic shock syndrome toxin-1 (TSST-1).[119]

Admission physical examination and laboratory values

A retrospective study compared admission physical examination findings and laboratory values of survivors versus those who died. Mortality was significantly higher in patients with:[121]

  • Lower mean WBC count ≤10 x 10⁹/L (10,000 cells/mm³)

  • Decreased mean platelet count ≤120 x 10⁹/L (120,000/mm³)

  • Higher serum creatinine ≥265.2 micromol/L (3 mg/dL)

  • Hypothermia, mean ≤37°C (98.6°F)

  • Decreased mean systolic BP ≤90 mmHg.

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