The association between serum potassium at hospital admission and the case-fatality rate of leptospirosis in men

Abstract

SUMMARYSevere leptospirosis affects predominantly males and presents a high susceptibility to hypokalemic acute renal failure. As hypokalemia and hyperkalemia induce severe complications, it is important to evaluate if the initial serum potassium is an independent risk factor for death in leptospirosis. The medical records of 1016 patients hospitalized with the diagnosis of leptospirosis were reviewed. The analysis was restricted to 442, according to the following criteria: male, 18 years or older, information about death or hospital discharge and recorded values of serum potassium, serum creatinine and duration of symptoms at admission. Potassium values lower than 3.5 mEq/L (hypoK), 3.5-5 mEq/L (normoK) and above 5 mEq/L (hyperK) were detected in 180, 245 and 17 patients, respectively. The death rate increased with serum potassium: 11.1% in the hypoK, 14.7% in the normoK and 47.1% in the hyperK group (p = 0.002). In a logistic regression model (normoK as referent), including age, creatinine and duration of symptoms, hypoK was not associated with increased death rate (odds ratio (OR) = 0.80; p > 0.1). On the other hand, hyperK showed a significant association with increased risk of death (OR = 3.95, p = 0.021). In conclusion, in this sample of men with leptospirosis initial serum potassium was positively and independently correlated with the risk of in-hospital death.

Renal involvement in leptospirosis: new insights into pathophysiology and treatment

“…Low potassium levels may be detected in 41%-45% of all patients with leptospirosis associated ARF [11,13]. A wasting sodium and potassium defect has been consistently documented by different groups [13][14][15].…”

“…Non-oliguric forms have better prognosis and oliguria and hyperkalemia have been identified as predictors of a lethal outcome [6,11,12].…”

Differences in Clinical Manifestations of Imported versus Autochthonous Leptospirosis in Austria and Germany

“…15 There is, however, currently no consistent definition of what characterizes "severe forms" of leptospirosis, although several factors associated with an increased risk of fatal outcome (therefore being prognostically relevant) have been identified over the past decade ( Table 1 ). 8,[16][17][18][19][20][21][22][23][24][25][26] In Austria and Germany, leptospirosis is a rare disease overall. Usually less than 60 cases are notified in Germany annually with the actual incidence being 0.06/100,000 per year.…”

Penicillin at the late stage of leptospirosis: a randomized controlled trial

“…Leptospirosis is a worldwide zoonotic disease caused by Leptospira interrogans 10,14,15,18 . The severe cases are characterized by a high frequency of jaundice, acute renal failure, bleeding complications, heart failure, cardiac arrhythmias and respiratory failure 6,10,17,19,20,22 . In Salvador, a large city located in the state of Bahia in Northeast Brazil, the disease is endemic with outbreaks occurring in close relation to the increase in the pluviometric precipitation 4,5,16 .…”

“…The in-hospital case-fatality rate of leptospirosis in Salvador is approximately 12% 25 . This high death rate may be partly explained by the high frequency of severe disease among patients hospitalized with leptospirosis in Salvador 16,17 . The highest mortality risk has been described among patients who need mechanical ventilation or develop oliguric acute renal failure 19,23 .…”