Rudra P Goswami1, Rama P Goswami2, Ayan Basu2, Santanu Kumar Tripathi3, Sanghamitra Chakrabarti4, Indrajit Chattopadhyay4. 1. Department of Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, India rudra.goswami@gmail.com. 2. Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India. 3. Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India. 4. Geriatric & General (Internal) Medicine, Glan Clwyd Hospital, Rhyl, Wales, LL18 5UJ, UK.
Abstract
BACKGROUND: Leptospirosis has a mortality rate of 5-20%. Poor prognostic factors are older age; oliguria; elevated potassium, creatinine and/or bilirubin levels; and altered mental status. We conducted this retrospective study to analyse the predictors of mortality among Indian patients with leptospirosis. METHODS: Clinical, biochemical, demographic and treatment related data (time between onset of symptoms and commencement of leptospira specific antibiotics) of 101 leptospirosis patients were reviewed. Predictors identified by univariate analysis were analysed by multivariable Cox regression for survival analysis. RESULTS: Prominent clinical features were: fever (101/101, 100%), jaundice (62, 62.4%), vomiting (42, 41.6%), oliguria (35, 34.7%), cough (18, 17.8%) and dyspnoea (10, 10.0%). Common complications were acute kidney injury (22, 21.8%), cardiovascular collapse (13, 12.9%), haemorrhages (10, 10.0%), meningitis (7, 6.9%), acute respiratory distress syndrome and pancreatitis (5, 5.0% each). Seventeen patients died (16.8%). Univariate predictors of mortality were older age, delayed antibiotic therapy, higher bilirubin, aspartate aminotransferase, alkaline phosphatase, leucocyte count and aspartate/alanine aminotransferase ratio (AAR). Only AAR (HR 1.208, 95% CI 1.051-1.388) and number of days the patient was symptomatic before access to specific antibiotic therapy (HR 1.304, 95% CI 1.081-1.574) remained significant predictors after Cox regression. CONCLUSIONS: Multivariate analysis showed high AAR and delayed antibiotic therapy might be associated with fatality.
BACKGROUND:Leptospirosis has a mortality rate of 5-20%. Poor prognostic factors are older age; oliguria; elevated potassium, creatinine and/or bilirubin levels; and altered mental status. We conducted this retrospective study to analyse the predictors of mortality among Indian patients with leptospirosis. METHODS: Clinical, biochemical, demographic and treatment related data (time between onset of symptoms and commencement of leptospira specific antibiotics) of 101 leptospirosispatients were reviewed. Predictors identified by univariate analysis were analysed by multivariable Cox regression for survival analysis. RESULTS: Prominent clinical features were: fever (101/101, 100%), jaundice (62, 62.4%), vomiting (42, 41.6%), oliguria (35, 34.7%), cough (18, 17.8%) and dyspnoea (10, 10.0%). Common complications were acute kidney injury (22, 21.8%), cardiovascular collapse (13, 12.9%), haemorrhages (10, 10.0%), meningitis (7, 6.9%), acute respiratory distress syndrome and pancreatitis (5, 5.0% each). Seventeen patients died (16.8%). Univariate predictors of mortality were older age, delayed antibiotic therapy, higher bilirubin, aspartate aminotransferase, alkaline phosphatase, leucocyte count and aspartate/alanine aminotransferase ratio (AAR). Only AAR (HR 1.208, 95% CI 1.051-1.388) and number of days the patient was symptomatic before access to specific antibiotic therapy (HR 1.304, 95% CI 1.081-1.574) remained significant predictors after Cox regression. CONCLUSIONS: Multivariate analysis showed high AAR and delayed antibiotic therapy might be associated with fatality.
Authors: Tyler M Sharp; Brenda Rivera García; Janice Pérez-Padilla; Renee L Galloway; Marta Guerra; Kyle R Ryff; Dana Haberling; Sharada Ramakrishnan; Sean Shadomy; Dianna Blau; Kay M Tomashek; William A Bower Journal: PLoS Negl Trop Dis Date: 2016-02-25
Authors: Elizabeth De Francesco Daher; Douglas Sousa Soares; Anna Tereza Bezerra de Menezes Fernandes; Marília Maria Vasconcelos Girão; Pedro Randal Sidrim; Eanes Delgado Barros Pereira; Natalia Albuquerque Rocha; Geraldo Bezerra da Silva Journal: BMC Infect Dis Date: 2016-02-01 Impact factor: 3.090