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

Abstract

Background: Pulmonary hemorrhage is the most common cause of mortality in severe leptospirosis. Rapid identification of patients likely to develop pulmonary complications will prompt aggressive management and improve survival. Objectives: To identify predictors of pulmonary complications in severe leptospirosis patients with kidney failure. Materials and Methods: A retrospective cohort of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI) from January to December 2018 was reviewed. Logistic regression was used to predict pulmonary complications and to obtain a scoring tool. Kaplan-Meir was used to describe survival rates. Results: Among 380 patients with severe leptospirosis and kidney failure, over-all mortality was 14% with pulmonary hemorrhage as the most common cause. There were 85 (22.4%) who developed pulmonary complications, majority (95.3%) observed within three days of admission. Among patients with pulmonary complications, 56.5% died. Patients on mechanical ventilation had an 82.1% mortality. Multivariate analyses showed dyspnea (OR=28.76, p 2 (63% sensitivity, 88% specificity). Conclusion: Pulmonary complications in severe leptospirosis with kidney failure has high mortality and warrants timely and aggressive management. A simple scoring system will aid in early identification and management. Funding Statement: The authors received no financial support for the research, authorship, and/or publication of this article. Declaration of Interests: There are no financial conflicts of interest to disclose. Ethics Approval Statement: Upon approval of the Technical Review Board, the protocol was submitted to the Research Ethics Committee of NKTI and was issued ethics clearance. Only the investigators and data collectors had access to the patient charts. A unique code number was assigned to each chart abstracted.