Prognosis

Mortality ranging from 30% to 85% has been reported for streptococcal toxic shock syndrome (TSS), despite prompt antibiotic therapy.​​​[32][33][40][45][46][62][98][114][115]​​ Death is usually due to cardiac arrhythmias, cardiomyopathy, and respiratory failure.[116][117]​ Higher mortality is associated with necrotizing fasciitis and TSS.[62] Shock is the most important predictor of death.[118] Advanced age, hypotension, and multiorgan system failure are significantly associated with increased mortality.[119]

Menstrual staphylococcal TSS has a mortality of approximately 8%.[120]​ One study in the US found a higher mortality rate in nonmenstrual TSS compared with menstrual TSS.[20] However, a study in the UK reported no difference in mortality between menstrual and nonmenstrual TSS.[19]​​ Mortality may be higher in staphylococcal TSS associated with toxins other than toxic shock syndrome toxin-1 (TSST-1).[118]

Admission physical exam and laboratory values

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

  • Lower mean WBC count ≤10,000 cells/mm³

  • Decreased mean platelet count ≤120,000/mm³

  • Higher serum creatinine ≥3 mg/dL

  • Hypothermia, mean ≤98.6°F (37°C)

  • Decreased mean systolic BP ≤90 mmHg.

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