Predictors of Severe Leptospirosis on Admission: A Sri Lankan Study

Abstract

Introduction: Intro Leptospirosis is a re-emerging zoonosis endemic to Sri Lanka. Considerable variation is seen in the clinical manifestations among leptospirosis patients and spectrum ranges from uncomplicated febrile illness to multi-organ failure and death. Therefore, this study aimed to identify severity predictors among a leptospirosis cohort in Sri Lanka. Method: This was a prospective hospital-based study carried out during 2017 in 2 selected hospitals in Western province of Sri Lanka. Clinically suspected leptospirosis patients were enrolled according to Communicable Disease Epidemiology Profile, WHO. Leptospirosis was confirmed by MAT titer ≥1:320, culture or by polymerase chain reaction. Leptospirosis confirmed patients were divided into patients with and without complications based on acute kidney injury, pulmonary hemorrhage, myocarditis and liver failure. Findings: Among 79 leptospirosis confirmed patients, a total of 28 (35.44%) patients developed complications. The mean age of patients was 45.05±16.19 and most were males (87.34%). The major complications were acute kidney injury (68%), pulmonary hemorrhage (36%), liver failure (36%) and myocarditis (14%). Having dyspnea (OR-7.10; CI-1.31-38.42; p=0.023), icterus (OR-6.45; CI1.72-24.05; p=0.006), oliguria (OR-5.22; CI-1.87-14.59; p=0.002) and cardiac arrythmias (OR-5.92; CI1.05-33.24; p=0.043) as clinical manifestations on admission were significantly associated with leptospirosis complications. Further patients with white blood cell >11,000 mm3 (OR-3.64; CI-1.34-9.86; p=0.011), neutrophil >75% (OR-13.41; CI-1.66- 108.10; p=0.015), serum glutamicoxaloacetic transaminase >40 U/L (OR-5.89; CI-1.21-28.53; p=0.028), serum creatinine >120 μmol/L (OR-29.14; CI-6.05-140.22; p6.5 mmol/L (OR-15.00; CI-1.82-123.56; p=0.012) and total bilirubin >21 μmol/L (OR15.20; CI-3.48-66.33; p<0.001) in laboratory investigation were defined as independent risk factors among patients with complications. Conclusion: Identified clinical and laboratory parameters can help clinicians to rapidly identify patients at risk of developing complications of leptospirosis, prompting aggressive treatment, advanced supportive care and close monitoring.