Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study

Rajapakse, Senaka; Weeratunga, Praveen; Niloofa, M.J.R.; Fernando, Narmada; Rodrigo, Chaturaka; Maduranga, Sachith; Fernando, Nipun Lakshitha; Silva, Nipun Lakshitha de; Karunanayake, Lilani; Handunnetti, SM

doi:10.1093/trstmh/trv079

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…The criteria of definingdisease complications; myocarditis, acute respiratory distress syndrome, pulmonary haemorrhage, acute liver failure, acute renal injury, shock and multi-organ dysfunction syndrome mentioned in the Table 2 were adopted from Rajapakse etal. 2015 [ 37 ]…”

Section: Resultsmentioning

confidence: 99%

Protein Carbonyl as a Biomarker of Oxidative Stress in Severe Leptospirosis, and Its Usefulness in Differentiating Leptospirosis from Dengue Infections

et al. 2016

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Pathogenesis of disease severity in leptospirosis is not clearly understood whether it is due to direct damage by pathogen or by adverse immune responses. Knowledge on biomarkers of oxidative stress which could be used in identifying patients with severe illness has shown to be of great value in disease management. Thus, the main aim of this study was to assess the damage to serum proteins and lipids, and their significance as biomarkers of oxidative stress in severe leptospirosis. In regions endemic for both leptospirosis and dengue, leptospirosis cases are often misdiagnosed as dengue during dengue epidemics. Therefore, the second aim was to assess the potential of the oxidative stress markers in differentiating severe leptospirosis from critical phase dengue. We measured serum antioxidants (uric acid and bilirubin), total antioxidant capacity (AOC), protein carbonyl (PC) and lipid hydroperoxide (LP) in patients with severe leptospirosis (n = 60), mild leptospirosis (n = 50), dengue during the critical phase (n = 30) and in healthy subjects (n = 30). All patient groups had similar total antioxidant capacity levels. However, the presence of significantly high uric acid and total bilirubin levels may reflect the degree of renal and hepatic involvement seen in severe leptospirosis patients (p<0.02). Serum PC and LP levels were significantly higher in leptospirosis patients compared to critical phase dengue infections (p<0.005). Moreover, high serum PC levels appear to differentiate SL from DC [area under the curve (AUC) = 0.96; p<0.001]. Serum PC may be a reliable biomarker of oxidative damage to serum proteins to identify severe leptospirosis patients (AUC = 0.99) and also to differentiate severe leptospirosis from mild cases (AUC = 0.78; p<0.005) indicating its contribution to pathogenesis. Use of serum PC as an indicator of leptospirosis severity and as an oxidative stress biomarker in differentiating leptospirosis from dengue would provide the opportunity to save lives via prompt patient management.

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Section: Resultsmentioning

confidence: 99%

Protein Carbonyl as a Biomarker of Oxidative Stress in Severe Leptospirosis, and Its Usefulness in Differentiating Leptospirosis from Dengue Infections

et al. 2016

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“…39,40 Some studies found hypotension, haemorrhage, cardiovascular collapse, male gender, old age, alcohol intake, hight ALT, high bilirubin, metabolic acidosis and need for ventilatory support to be predictors of poor prognosis. 3,14,31,41 In the present study, hepato-renal involvement, presence of underlying cirrhosis and need for artificial ventilation were predictors of mortality. Similar results have been reported by Somasundaram et al 15 where all the deaths were due to cirrhosis and hepato-renal involvement.…”

Section: Discussionmentioning

confidence: 48%

Hepatic dysfunction and predictors of mortality in Leptospirosis: A re-emerging tropical disease in northern India

Goyal

2016

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Background: Leptospirosis can present with varied clinical manifestations ranging from mild self-limiting illness to severe disease with multiorgan involvement. There is limited data on the hepatic dysfunction in leptospirosis, especially in patients with underlying cirrhosis.This study aimed to analyse the hepatic dysfunction due to leptospirosis in both cirrhotic and non-cirrhotic patients, and subsequently identify predictors of mortality. Methods: Medical records of serologically confirmed cases of leptospirosis admitted to a tertiary care centre over one year period were analysed retrospectively. Clinical features including hepatic dysfunction in patients with and without underlying cirrhosis were compared. Multivariate regression analysis was performed to find predictors of mortality. Results: 257 patients of leptospirosis were screened. After exclusion, 204 patients (mean age-45.2 ±11.4 years; male:female=4.1:1) were enrolled, of whom 46.6% (n=95) had underlying cirrhosis. The 2 groups i.e. cirrhotics (n=95) and non-cirrhotics (n=109) were compared. Proportion of patients with hepatic involvement (91.6% vs 61.5%;p=0.0001), hepato-renal involvement (58.9% vs. 43.8%;p=0.024) and neurological involvement (54.7% vs 24.8%;p=0.0001) were significantly higher in cirrhotic group, while those with pulmonary or renal involvement were similar in both groups. Mean bilirubin was significantly higher, while transaminases, albumin, platelet counts and fever at presentation (74.7% vs 94.4%) were significantly lower in cirrhotic group. Cirrhotics had significantly higher mortality compared to non-cirrhotics (29.5% vs 20.2%;p=0.047). On multivariate analysis, hepato-renal involvement, presence of cirrhosis and need for artificial ventilation correlated with mortality. Conclusion: Hepatic dysfunction in patients with leptospirosis was common, and a significant proportion of these patients had underlying cirrhosis. Compared to non-cirrhotics, cirrhotics were more likely to have afebrile presentation, higher chances of hepato-renal and neurological involvement, and higher mortality.

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“…Previous studies about the clinical factors associated with severe leptospirosis have shown signs and symptoms like hemorrhage [ 33 ], pulmonary signs and symptoms (abnormal lung sounds, dyspnea) [ 33 ], hypotension, oliguria, jaundice [ 52 , 53 ], and hyperkalemia [ 33 ]. Laboratory testing as packed cell volume (PCV: 29.8%), hyponatremia (<131 mEq/L), and highest alanine transaminase (ALT: 70 IU/L) were found to be independently associated with severe disease [ 52 , 54 ]. We found rash, dyspnea, tachycardia, and jaundice associated with severe leptospirosis.…”

Section: Discussionmentioning

confidence: 99%

Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015–2020

Parra Barrera,

Bello Piruccini,

Rodríguez

et al. 2023

PLoS Negl Trop Dis

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Background Leptospirosis is a common zoonoses and is a major global public health threat. Most cases are mild, typically presenting as a non-specific acute febrile illness. However, leptospirosis can have life-threatening manifestations, including pulmonary hemorrhage syndrome, and acute kidney injury. In Colombia, notification and lab-confirmation of suspected human cases are mandatory. However, little is known about the demographic and clinical factors associated with severe leptospirosis, which could help to reduce clinical complications and mortality. Our aim was to identify risk factors associated with severe leptospirosis, intensive care unit (ICU) admission, and mortality in lab-confirmed cases in Colombia, 2015–2020. Methods and findings We analyzed 201 lab-confirmed human leptospirosis cases by microagglutination test. We used a logistic regression to identify the demographic and clinical risk factors associated with severe leptospirosis, admission to ICU, and death. Most leptospirosis confirmed cases occurred in men (85.6%); the mean age was 36.7 years. We classified severe cases (43.3%) by clinical manifestations as renal (29.9%) and liver (27.4%) failure, multiple-organ failure (24.4%), septic shock (24.4%), Weil syndrome (18.4%), pulmonary hemorrhage (18.4%), and meningitis (2.5%), admitted to the ICU (30.3%), and fatal (8.5%). Clinical conditions associated with severe leptospirosis were dyspnea (OR: 5.54; 95% CI: 1.46 to 20.98), tachycardia (OR:9.69; 95% CI: 15.96 to 58.8), and rash (OR: 10.25; 95% CI: 25.01 to 42.08). Conclusions We identified demographic characteristics and clinical symptoms associated with severe leptospirosis in Colombia. We hope these results can support clinicians in providing timely treatment to leptospirosis patients to avoid preventable medical complications or deaths.

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Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study

Abstract: Severity associations were demonstrated with both clinical and laboratory parameters. There is a need for novel biomarkers for prediction of severity in leptospirosis.

Cited by 12 publications

References 29 publications

Protein Carbonyl as a Biomarker of Oxidative Stress in Severe Leptospirosis, and Its Usefulness in Differentiating Leptospirosis from Dengue Infections

Protein Carbonyl as a Biomarker of Oxidative Stress in Severe Leptospirosis, and Its Usefulness in Differentiating Leptospirosis from Dengue Infections

Hepatic dysfunction and predictors of mortality in Leptospirosis: A re-emerging tropical disease in northern India

Demographic and clinical risk factors associated with severity of lab-confirmed human leptospirosis in Colombia, 2015–2020

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