Abstract
Introduction. Severe leptospirosis, also known as Weil's disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. Methods. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Data were collected retrospectively, with approval from the Institution Ethics Committee. Results. Ten patients with severe leptospirosis were admitted in the Patras University Hospital ICU in a four-year period. Although, based on SOFA scores, predicted mortality was over 80%, seven of 10 patients survived and were discharged from the hospital in good condition. There was no association between SAPS II or SOFA scores and mortality, but survivors had significantly lower APACHE II scores compared to nonsurvivors. Conclusion. Commonly used severity scores do not seem to be useful in predicting mortality in severe leptospirosis. Early ICU admission and resuscitation based on a goal-directed therapy protocol are recommended and may reduce mortality. However, this study is limited by retrospective data collection and small sample size. Data from large prospective studies are needed to validate our findings.
Highlights
Severe leptospirosis, known as Weil’s disease, can cause multiorgan failure with high mortality
The discordance between observed mortality and Sequential Organ Failure Assessment (SOFA)-predicted mortality in our study could be attributed to statistical error due to our small number of patients or errors in calculating mortality predicted by SOFA score
Other plausible explanations include real differences between our leptospirosis ICU patient population and the SOFA reference population [43] or greater potential for organ recovery when organ dysfunction is caused by leptospirosis
Summary
Known as Weil’s disease, can cause multiorgan failure with high mortality. Scoring systems for disease severity have not been validated for leptospirosis, and there is no documented method to predict mortality. This is a case series on 10 patients admitted to ICU for multiorgan failure from severe leptospirosis. Sepsis and multiple organ failure are associated with high ICU morbidity and mortality. Available organ failure scoring systems, such as the Sequential Organ Failure Assessment (SOFA) score can help assess organ dysfunction over time and have been associated with ICU mortality. Weil syndrome can cause respiratory failure [3], renal failure requiring hemodialysis [4], hemorrhages, anemia, disturbances in consciousness, and persistent fever and sepsis with high mortality, even in previously healthy patients [5]
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