Endothelial biomarkers as predictors for haemodialysis need in severe leptospirosis patients (Weil's disease).

Abstract

To investigate the prediction ability of vascular injury biomarkers for haemodialysis requirement in patients with severe leptospirosis. Prospective study with severe leptospirosis patients hospitalised in Fortaleza, Brazil. Blood samples were collected hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to haemodialysis requirement during hospital stay. Twenty-seven patients were included, with a mean age of 39 ± 18 years. 88.9% were males. 53.8% needed haemodialysis and presented higher levels on hospital admission of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/ml; p= 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/ml; p= 0.01), and FGF-23 (291 [56-2031] vs. 10 [10-806] pg/ml; p= 0.021). Syndecan-1 showed significant correlation with creatinine (r= 0.546; p= 0.05) and total bilirubin levels (r= 0.534; p= 0.013) on hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r= 0.513; p= 0.009) on hospital admission and with number of haemodialysis sessions (r= 0.406; p= 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict haemodialysis need in patients with severe leptospirosis (AUC-ROC=0.744 [95% CI: 0.545-0.943] p= 0.035). Syndecan-1 and angiopoietin-2 were associated with haemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality.