Predictors of Disease Severity of Leptospirosis on Admissio - A Sri Lanka Study

Abstract

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Background – leptospirosis is a potentially lethal zoonotic disease. Limited information is available on disease severity of leptospirosis (Tubiana et.al, 2013.). Predictors of disease severity on admission will help the clinician to anticipate serious complications. This study was designed to analysis the severity predictors of leptospirosis. Method – Patients with suspected leptospirosis based on the WHO surveillance criteria ( WHO,2021) were recruited at three major hospitals in Sri Lanka in 2015.conformation was based on microscopic agglutination (MAT titre>1:400) or polymerase chain reaction tests. Patients were divided into severe and non- severe groups based on acute kidney injury, acute respiratory distress syndrome, acute myocarditis and liver failure. Analysis of clinical and laboratory patterns on admission, were done to identify predictors of severer disease. Results – Out of 62 leptospirosis patients, 19 had severe disease. Sub-conjuctival hemorrhages (OR- 3.18; CI- 0.96-10.47; p=0.05), jaundice (OR-4.99; CI- 1.57-15.86; p=0.006), hemoglobin <12g/dl (OR- 3.2;CI-1.04-9.84; p=0.04),white blood cell count >11×10 / L(OR-6.02;CI-1.76-20.61;p=0.004), platelet count <100×10 /L(OR-5.51;CI-1.67-18.17; p=0.005) ,blood urea>10mmol/L(OR- 7.13;CI-2.07-24.54; p=0.002) and serum creatinine>120 micmol/L (OR-11.43;CI-2.49-52.51; p=0.001)on admission, were significantly associated with server leptospirosis. Conclusions – Clinical features and laboratory investigations predict severe leptospirosis on admission. Presence of these of these will need aggressive treatment and close monitoring.