Description

Severe cases of leptospirosis may be fatal. Identification of risk factors for a fatal outcome may help identify patients who would benefit from early and aggressive interventions.


 

Risk factors identified by Daher et al:

(1) oliguria (only independent factor for death by logistic regression)

 

Risk factors identified by Dupont et al:

(1) dyspnea

(2) alveolar infiltrates on chest X-rays

(3) oliguria

(4) repolarization abnormalities in the ECG

(5) leukocyte count > 12,900 per µL

 

Risk factors identified by Ko et al using multivariate analysis:

(1) altered mental status (strongest independent predictor of death), with confusion , obtundation, stupor or coma

(2) increasing age (age > 37 years)

(3) renal insufficiency (oliguria, serum creatinine > 354 µmol/L, BUN > 54 mmol/L)

(4) respiratory insufficiency

The presence of altered mental status, renal failure plus increasing age had an 82% positive predictive value for death.

 

Risk factors identified by Marotto et al in patients with acute lung injury:

(1) shock (defined as need for vasoactive drugs to maintain systolic blood pressure >= 80 mm Hg after fluid replacement therapy)

(2) serum creatinine level > 265.2 µmol/L (> 3.0 mg/dL)

(3) serum potassium > 4.0 mmol/L

 

Other factors reported to be associated with poor prognosis, but not confirmed during data analysis:

(1) increasing age

(2) jaundice with elevated total serum bilirubin

(3) female gender

 


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