Impact of clinical and laboratory findings on prognosis in leptospirosis

Abstract

Objective: The aim of this study was to evaluate epidemiological, clinical and laboratory features, and risk factors for mortality in leptospisrosis. Methods: Seventy-two adult leptospirosis cases were reviewed. Categorical clinical and laboratory findings of survivors and non-survivors were assessed by Chi square analysis. Non-categorical findings were assessed by the student t test. Clinical findings and laboratory data with p <0.05 were assessed by stepwise logistic regression analysis for mortality. Results: Of all patients, mean age was 47.3 ± 15.7 years, 82 % were men and, 51 % were farmers. Icterus occurred in 75 %, and high fever was seen in 61 of the patients. The most frequently detected serotype was Leptospira icterohaemorrhagiae (30%). Overall mortality rate was 17%. In those non-survivors, altered mental status (p = 0.002), hepatomegaly (p = 0.037), haemorrhage (p = 0.019), ALT level (p = 0.008), AST level (p= 0.02), prolonged prothrombin time (p = 0.02) and increased serum potassium levels (p = 0.004) were seen more frequently than in survivors. Altered mental status (p= 0.01, OR: 8.9, CI95%:1.6-50.7) and serum potassium levels at hospital admission (p = 0.01, OR: 4.2, CI 95%: 1.4-13.1) were detected as independent risk factors for mortality. Conclusions: Leptospirosis patients with altered mental status and hyperpotassaemia at hospital admission are at high risk for mortality and should be followed up more closely at the intensive care unit.