Benjamin Delmas1, Julien Jabot1, Paul Chanareille1, Cyril Ferdynus2, Jérôme Allyn1, Nicolas Allou1, Loïc Raffray3, Bernard-Alex Gaüzere1,4, Olivier Martinet1, David Vandroux1,4,5. 1. Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, CS11021, Saint Denis, Reunion Island, France. 2. Unité de Soutien Méthodologique, Félix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France. 3. Internal Medicine Unit, Felix Guyon Hospital, University Teaching Hospital of La Réunion, Saint Denis, France. 4. René Labusquiere Centre of Tropical Medicine, University of Bordeaux, Bordeaux Cedex, France. 5. INSERM, CIC 1410, Saint-Pierre, France.
Abstract
OBJECTIVES: Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis. DESIGN: Retrospective, descriptive, and single-center cohort study. SETTINGS: The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital. PATIENTS: Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30-52 yr), with a Simplified Acute Physiology Score II of 38 (27-50) and a Sequential Organ Failure Assessment score of 10 (8-12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0-1) day after admission with a median urea of 25 mmol/L (17-32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6-11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 - 0.79). CONCLUSIONS: The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.
OBJECTIVES:Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis. DESIGN: Retrospective, descriptive, and single-center cohort study. SETTINGS: The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital. PATIENTS: Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30-52 yr), with a Simplified Acute Physiology Score II of 38 (27-50) and a Sequential Organ Failure Assessment score of 10 (8-12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0-1) day after admission with a median urea of 25 mmol/L (17-32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6-11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 - 0.79). CONCLUSIONS: The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.
Authors: Kris Salaveria; Simon Smith; Yu-Hsuan Liu; Richard Bagshaw; Markus Ott; Alexandra Stewart; Matthew Law; Angus Carter; Josh Hanson Journal: Am J Trop Med Hyg Date: 2021-10-18 Impact factor: 3.707
Authors: Rizza Antoinette Yap So; Romina A Danguilan; Eric Chua; Mel-Hatra I Arakama; Joann Kathleen B Ginete-Garcia; Joselito R Chavez Journal: Trop Med Infect Dis Date: 2022-01-11