PROGNOSTIC SCORE FOR SEVERITY OF LEPTOSPIROSIS

Abstract

The case-fatality rate of leptospirosis rises above 50% if intensive treatment is delayed. Our purpose was to create a simple score that could be used quickly to identify patients at the greatest risk. Material and Methods: One hundred consecutive patients with leptospirosis treated in the Clinic of Infectious Diseases at University Hospital “Dr Georgi Stranski” - Pleven (1976-2018) were distributed retrospectively in groups with a non-severe and severe course (66 and 34, respectively). The once interesting prognosis was an eventual risk for the severe course. Data were analyzed using statistical software (IВМ SPSS Statistics 19.0). Results: The multivariate analysis identified seven variables independent associated with severe course: age ≥60 years OR (95% CI):15.45 (12.21–19.7), hospital admission >4 days after the clinical onset OR (95% CI):4.18 (2.23–7.86; oligo/anuria OR (95% CI):10.95 (3.2–19.8); hypotension OR (95% CI):13.936 (6.5–19.9); pulmonary findings OR (95% CI):25.45 (17.5–32.4); arrhythmia OR (95% CI):15.5 (10.2–19.6), and hemorrhages OR (95% CI):21.6 (18.3– 29.7). The mentioned variables (awarded one point each) were used to generate a seven-point prognostic score. The risk for severe course increased incrementally. A score of two, three, four or five had a positive predictive value of 30%, 38%, 74% and 89%, respectively (95% CI:28–39, 32–43, 60 – 90, 70–92, respectively). A score of six or seven had a positive predictive value of 100% (95% CI: 96–100 and 98–100, respectively). Conclusion: A simple seven-point clinical based prognostic score would help clinicians identify people at risk of severe leptospirosis and initiate prompt intensive treatment, including hemodialysis.