Comparative study of the in-hospital case-fatality rate of leptospirosis between pediatric and adult patients of different age groups

Abstract

The main objective was to compare the in-hospital case-fatality rate of leptospirosis between pediatric (< 19 years) and adult (>19 years) patients, taking into account gender, renal function, duration of symptoms and jaundice. Medical records of 1016 patients were reviewed. Comparative analysis was restricted to 840 patients (100 pediatric, 740 adults) with recorded information on the variables included in the analysis. Among these patients 81.7% were male and 91.5% were icteric. The case-fatality rate of leptospirosis was 14.4%. The odds of death adjusted for gender, jaundice, duration of symptoms, serum urea and serum creatinine were almost four times higher for the adult than for the pediatric group (odds ratio (OR) = 3.94; 95% confidence interval = 1.19-13.03, p = 0.029). Among adults, increased age was also significantly and independently associated with increased risk of death (p < 0.01). Older patients were also more often treated by dialysis. In conclusion, the data suggest that the in-hospital case fatality rate of leptospirosis is higher for adults than for children and adolescents, even after taking into account the effects of several potential risk factors of death. Among adults, older age was also strongly and independently associated with higher risk of death.

The kidney in leptospirosis

“…In a retrospective study of 840 inhospital cases of leptospirosis, 12% were <19 years. Plasma creatinine and blood urea in this group were lower than in adults, respectively, (3.3±1.17 and 121.8±80.3 mg/dl vs. 4.2± 2.5 and 155.0 ± 100.6 mg/dl, P ≤ 0.001) for both parameters [28]. There are few studies in children reporting the frequency of ARF.…”

“…However, in hospitalized patients, the fatality rate can be higher. In Brazil, among 840 hospitalized patients, the comparison between patients <19 years old and those ≥19 years old showed an in-hospital fatality rate of 3% in the first group and 15.9% in the latter [28]. In a retrospective analysis of 43 children 4-14 years old hospitalized in Brazil, 79% of whom had ARF and 7% with pulmonary hemorrhage, only one death occurred (2%) [51].…”

Comparative Analysis of Severe Pediatric and Adult Leptospirosis in São Paulo, Brazil

“…19 years of age also reported lower rates of jaundice among children and adults (80% versus 93%, respectively) and a lower case-fatality rate in pediatric patients (3% versus 16%, respectively). 14 Although severe disease and death caused by leptospirosis may occur in pediatric age groups and there may be significant disease overlap with the spectrum seen in adults, the frequency of several classic severe disease manifestations and overall case-fatality rates were significantly lower among children in this study and among patients with severe renal and pulmonary disease. These differences did not appear related to differences in seroreactivity to leptospiral serogroups; the latter was similar in both groups.…”

Comparative Analysis of Pediatric and Adult Leptospirosis in Pleven Region, Bulgaria

“…Severe pediatric leptospirosis may be less likely to show all classic features of Weil's disease and may be less fatal than in adults [23] but according to Guerrier G et al (2013) severe leptospirosis in adolescents may be more likely to show adults' characteristics compared with children [24]. Lopes AA et al (2003) had concluded that pediatric patients have a lower risk of death during hospitalization than adults with leptospirosis [25].…”