OBJECTIVES: To determine the prognostic factors of death in leptospirosis. METHODS: A prospective cohort study was conducted. One hundred and twenty one patients with clinically compatible leptospirosis, serologically confirmed, were recruited in this study. Clinical presentations and biochemical parameters on admission were selected as input variables for survival analysis. Multivariable Cox regression model was used to identify the prognostic factors of death. RESULTS: Most patients were male (94.2%), with the mean +/-SD age of 38+/-13.4 years; 77.4% of them were farmers. Among the 121 patients, 1206 patient-days were observed. Seventeen patients died. Overall mortality rate was 1.4 per 100 patient-days (95% confidence interval [CI]: 0.9-2.3). The causes of death included: a) pulmonary hemorrhage in eight (47.1%) patients; b) complicated acute renal failure in three (17.6%) patients; c) multiple organ failure in three (17.6%) patients; d) acute respiratory distress syndrome in two (11.8%) patients, and e) irreversible shock in one (5.9%) patient. Four independent risk factors associated with the mortality were identified, including hypotension (relative risk [RR], 10.3; 95% CI, 1.3-83.2; P<0.05); oliguria (RR, 8.8; 95% CI, 2.4-31.8; P<0.01); hyperkalemia (RR, 5.9; 95% CI, 1.7-21; P<0.01), and presence of pulmonary rales (RR, 5.2; 95% CI, 1.4-19.9; P<0.05). CONCLUSION: The presence of oliguria, hyperkalemia, pulmonary rales, or hypotension on admission in patients with leptospirosis indicated high risk of death. Intensive care and early intervention should be provided for patients who present with these risk factors.
OBJECTIVES: To determine the prognostic factors of death in leptospirosis. METHODS: A prospective cohort study was conducted. One hundred and twenty one patients with clinically compatible leptospirosis, serologically confirmed, were recruited in this study. Clinical presentations and biochemical parameters on admission were selected as input variables for survival analysis. Multivariable Cox regression model was used to identify the prognostic factors of death. RESULTS: Most patients were male (94.2%), with the mean +/-SD age of 38+/-13.4 years; 77.4% of them were farmers. Among the 121 patients, 1206 patient-days were observed. Seventeen patients died. Overall mortality rate was 1.4 per 100 patient-days (95% confidence interval [CI]: 0.9-2.3). The causes of death included: a) pulmonary hemorrhage in eight (47.1%) patients; b) complicated acute renal failure in three (17.6%) patients; c) multiple organ failure in three (17.6%) patients; d) acute respiratory distress syndrome in two (11.8%) patients, and e) irreversible shock in one (5.9%) patient. Four independent risk factors associated with the mortality were identified, including hypotension (relative risk [RR], 10.3; 95% CI, 1.3-83.2; P<0.05); oliguria (RR, 8.8; 95% CI, 2.4-31.8; P<0.01); hyperkalemia (RR, 5.9; 95% CI, 1.7-21; P<0.01), and presence of pulmonary rales (RR, 5.2; 95% CI, 1.4-19.9; P<0.05). CONCLUSION: The presence of oliguria, hyperkalemia, pulmonary rales, or hypotension on admission in patients with leptospirosis indicated high risk of death. Intensive care and early intervention should be provided for patients who present with these risk factors.
Authors: Anne S Spichler; Pedro J Vilaça; Daniel A Athanazio; Jose O M Albuquerque; Marcia Buzzar; Bronislawa Castro; Antonio Seguro; Joseph M Vinetz Journal: Am J Trop Med Hyg Date: 2008-12 Impact factor: 2.345
Authors: Angela S Barbosa; Patricia A E Abreu; Sílvio A Vasconcellos; Zenaide M Morais; Amane P Gonçales; Aldacilene S Silva; Mohamed R Daha; Lourdes Isaac Journal: Infect Immun Date: 2008-12-29 Impact factor: 3.441
Authors: Paulo C F Marotto; Albert I Ko; Cristiane Murta-Nascimento; Antonio C Seguro; Rogerio R Prado; Marcia C Barbosa; Sergio A Cleto; José Eluf-Neto Journal: J Infect Date: 2009-12-21 Impact factor: 6.072
Authors: Elves A P Maciel; Daniel A Athanazio; Eliana A G Reis; Fernando Q Cunha; Adriano Queiroz; Deusdelia Almeida; Alan J A McBride; Albert I Ko; Mitermayer G Reis Journal: Acta Trop Date: 2007-01-02 Impact factor: 3.112
Authors: Bodo Hoffmeister; Gabriele Peyerl-Hoffmann; Sven Pischke; Ines Zollner-Schwetz; Robert Krause; Matthias C Müller; Angelika Graf; Stefan Kluge; Gerd D Burchard; Winfried V Kern; Norbert Suttorp; Jakob P Cramer Journal: Am J Trop Med Hyg Date: 2010-08 Impact factor: 2.345
Authors: Eddy R Segura; Christian A Ganoza; Kalina Campos; Jessica N Ricaldi; Sonia Torres; Hermann Silva; Manuel J Céspedes; Michael A Matthias; Mark A Swancutt; Renzo López Liñán; Eduardo Gotuzzo; Humberto Guerra; Robert H Gilman; Joseph M Vinetz Journal: Clin Infect Dis Date: 2005-01-10 Impact factor: 9.079