A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure.

Rizza Antoinette Yap So,Romina A Danguilan,Eric Chua,Joselito R Chavez,Joann Kathleen B Ginete-Garcia,Mel-Hatra I Arakama

doi:10.3390/tropicalmed7010007

Rizza Antoinette Yap So, Romina A Danguilan + Show 4 more

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https://doi.org/10.3390/tropicalmed7010007

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Abstract

Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan–Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, p < 0.0001), hemoptysis (OR = 20.73, p < 0.0001), diabetes (OR = 10.21, p < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, p < 0.0001), thrombocytopenia (OR = 3.54, p < 0.0029), and oliguria/anuria (OR = 3.15, p < 0.0108) were significantly associated with pulmonary complications. A scoring index was developed termed THe-RADS score (Thrombocytopenia, Hemoptysis, RRT, Anuria, Diabetes, Shortness of breath). The odds of developing pulmonary complications were 13.90 times higher among patients with a score >2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management.

Highlights

Leptospirosis is a worldwide public health problem commonly encountered in humid tropical and subtropical areas where most developing countries are found [1]
Among 380 clinically diagnosed leptospirosis patients admitted in National Kidney and Transplant Institute (NKTI) from January to December 2018, 142 were positive in the IgM Leptospiral antibody test, 64 were positive in the microscopic agglutination test (MAT), and 56 were positive in the real-time PCR detection of pathogenic Leptospira spp
This study reviewed 380 severe leptospirosis patients admitted to NKTI in 2018, where 85 (22.4%) patients developed pulmonary complications

Summary

Introduction

Leptospirosis is a worldwide public health problem commonly encountered in humid tropical and subtropical areas where most developing countries are found [1]. It is caused by the pathogenic species of Leptospira, commonly L. interrogans, with L. icterohemorrhagica causing the severe form [2]. According to the government’s Department of Health, 1227 leptospirosis cases were recorded in Metro Manila from January to August 2018. This is a 358% increase from the 268 recorded cases during the same period in 2017 [5]. Overall mortality was 15.6% due mainly to pulmonary hemorrhage [7]

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