Building prognostic models for adverse outcomes in a prospective cohort of hospitalised patients with acute leptospirosis infection in the Philippines

Lee, Nathaniel; Kitashoji, Emi; Koizumi, Nobuo; Lacuesta, Talitha Lea; Ribo, Maricel R.; Dimaano, Efren M.; Saito, Nobuo; Suzuki, Motoi; Ariyoshi, Koya; Parry, Christopher M.

doi:10.1093/trstmh/try015

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…Pulmonary forms, male gender, delayed treatment, thrombocytopenia, oliguria, and hemoptysis are associated with fatal cases in different studies worldwide. 38 , 39 , 41 In our study, there was no difference in the delay before treatment between recovered and deceased leptospirosis cases. However, severe anemia and the presence of abdominal pain on admission were significantly associated with death.…”

Section: Discussionmentioning

confidence: 45%

“… 42 – 47 We were not able to assess links with hypotension or coagulation abnormalities as this information was missing in the medical files. The delay in treatment is often associated with severe forms, 39 , 45 , 47 although delays before treatment were very short in our study probably because of the small size of the country and access to free health facilities in most parts of the islands. Final clinical diagnosis was available only for 113 cases.…”

Section: Discussionmentioning

confidence: 52%

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An Observational Study of Human Leptospirosis in Seychelles

Biscornet

Comarmond

Bibi

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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. A 1-year population-based prospective study was launched in Seychelles, a country with one of the highest human incidence of leptospirosis worldwide, to describe the characteristic features of the epidemiology of the disease and highlight the most prominent risk factors. Diagnosis was based on the IgM enzyme-linked immunosorbent assay, microscopic agglutination test, and real-time PCR. A standardized questionnaire was administered to 219 patients aged ≥ 13 years consulting for acute febrile illness. The high incidence of leptospirosis in Seychelles was confirmed. The disease was particularly severe, as the case fatality rate was 11.8%. Leptospirosis was positively associated in univariate analysis with socio-professional and clinical variables including gardening/farming, oliguria, jaundice, conjunctivitis, history of hepatitis C virus infection, anemia, thrombocytopenia, and/or biological renal failure. Epidemiological analyses of the questionnaires highlighted a link of the disease with living in houses (versus apartment), the presence of animals around and in houses, gardening, and misuse of personal protective equipment. Multivariate analyses indicated that being a farmer/landscaper and having cattle and cats around the home are the most significant drivers of leptospirosis. Biological features most associated with leptospirosis were thrombocytopenia, leukocytosis, high values for renal function tests, and elevated total bilirubin. We report changes in behavior and exposure compared with data collected on leptospirosis 25 years ago, with indication that healthcare development has lowered case fatality. Continuous health education campaigns are recommended as well as further studies to clarify the epidemiology of human leptospirosis, especially the role of domestic animals.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 52%

An Observational Study of Human Leptospirosis in Seychelles

Biscornet

Comarmond

Bibi

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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“…The previous study found that adult males were the principal risk group for leptospirosis [ 21 ]. They had clinically more severe outcomes and higher severity of clinical leptospirosis [ 2 , 16 , 22 ]. Traditionally, this was attributed to the fact that males are usually more exposed to water, and engage in high-risk occupations or recreational activities that predispose them to leptospirosis [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported prognostic factors for predicting the severity of disease, including abnormal lung sound [ 8 , 9 , 10 , 11 ], hepatomegaly [ 8 ], oliguria [ 9 , 10 , 11 ], consciousness disorders [ 10 ], jaundice or icterus [ 10 , 12 , 13 ], hypotension [ 8 , 9 ], systolic blood pressure ≤ 100 mmHg [ 11 ], hemoptysis [ 12 ], acute kidney injury (AKI) [ 14 , 15 ], low platelet levels [ 12 , 14 , 15 ], high leukocytosis level [ 8 , 12 ], low hematocrit [ 8 , 12 ], high serum ALT and AST level [ 8 , 10 , 15 ], delayed treatment more than 2 days after the onset of illness [ 10 , 14 , 16 , 17 ], a history of high blood pressure [ 10 ], chronic alcoholism [ 10 ], current cigarette smoking [ 14 ], male [ 16 ], age > 36 years [ 17 ], and shock [ 18 ]. All studies reported varying prevailing epidemiology and microbiology for each factor.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors for Leptospirosis Infection Severity

et al. 2023

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Background: Leptospirosis is an important health problem in Thailand. People infected with leptospirosis may not have any mild symptoms, whereas some people have acute and severe illnesses. It is crucial to strengthen critical patients’ diagnosis and treatment to prevent severe complications and reduce mortality. This study was performed to explore a set of parameters for the prediction of severe leptospirosis illness under routine clinical practice. Methods: A case-control study was conducted in eight general hospitals in Thailand. Retrospective collection data were used, and key information was retrieved from inpatient medical files. Patients were grouped into two severity categories, severe and non-severe infection. Backward elimination was used to reach the final multivariate model. Results: The six significant predictors identified in the study were hemoptysis (OR = 25.80, 95% CI 5.69, 116.92), hypotension (blood pressure < 90/60 mmHg) (OR = 17.33, 95% CI 6.89, 43.58), platelet count < 100,000/µL (OR = 8.37, 95% CI 4.65, 15.09), white blood cell count (WBC) > 14,000/µL (OR = 5.12, 95% CI 2.75, 9.51), hematocrit ≤ 30% (OR = 3.49, 95% CI 1.61, 7.57), and jaundice (OR = 3.11, 95% CI 1.71, 5.65). These predictors could correctly predict the severity of leptospirosis infection in 91.31% of the area under the receiver operation curve (AuROC). Conclusions: The results of this study showed that severe leptospirosis infections have identifiable predictors. The predictors may be used to develop a scoring system for predicting the level of severity.

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“…During these epidemics, many concerns have been raised about the risk of confusion between leptospirosis and DF because the clinical-biological presentation during the acute phase of both diseases are often similar [ 6 – 11 ]. This confusion can be detrimental and carry a risk of delayed antibiotic treatment leading to increased mortality in leptospirosis patients [ 12 – 14 ], particularly when leptospirosis is misdiagnosed as DF [ 10 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area

Maillard,

Hirschinger,

Bénéteau

et al. 2023

PLoS ONE

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In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen.

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Building prognostic models for adverse outcomes in a prospective cohort of hospitalised patients with acute leptospirosis infection in the Philippines

Cited by 9 publications

References 24 publications

An Observational Study of Human Leptospirosis in Seychelles

An Observational Study of Human Leptospirosis in Seychelles

Prognostic Factors for Leptospirosis Infection Severity

C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area

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