Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital – a three year retrospective study

Weeratunga, Praveen; Fernando, Samitha; Sriharan, S.; Gunawardena, M.; Wijenayake, Sanoji

doi:10.1080/20477724.2015.1126032

Cited by 12 publications

(17 citation statements)

References 40 publications

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“…The highest death rates were reported from studies performed among Intensive care unit (ICU) patients. At General Hospital Kaluthara, 20 deaths out of 45 ICU patients confirmed for leptospirosis were reported, with a case fatality rate of 44.4% [19]. A study done among ICU patients at National Hospital of Sri Lanka reported a Case Fatality Rate (CFR) of 33.3%.…”

Section: Resultsmentioning

confidence: 99%

Estimating the burden of leptospirosis in Sri Lanka; a systematic review

2019

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BackgroundAlthough the assessment of disease burden should be a priority for allocating resources, leptospirosis is grossly underestimated despite its true burden in Sri Lanka. This study aimed to assess the morbidity and mortality of leptospirosis based on routine surveillance data, hospital reported data and scientific publications from Sri Lanka.MethodA systematic review was carried out, and Pub Med, MEDLINE®, BIOSIS Previews, Zoological Record, Web of Science Core Collection, Current Contents Connect, KCI-Korean Journal Database, BIOSIS Citation Index, Data Citation Index, SciELO Citation Index and Google Scholar databases were searched. Quarterly epidemiological bulletin (QEB), indoor morbidity & mortality returns (IMMR) and hand searches of local literature were performed in local libraries. Forty-two relevant full texts, 32 QEBs, and 8 IMMR were included in the full text review. Adjustments were made for under diagnosis, underreporting and chance variability.ResultsThe estimated annual caseload of leptospirosis in Sri Lanka from 2008 to 2015, was 10,423, and the cumulative annual incidence of leptospirosis that required hospitalization was 52.1 (95% CI 51.7–52.6) per 100,000 people. The estimated number of annual deaths due to leptospirosis was approximately 730 (95% CI 542–980), with an estimated pooled case fatality ratio of 7.0% (95% CI 5.2–9.4). The most common organs involved were the kidney, liver and heart, with median rates of 48.7, 30, and 14.2%, respectively.ConclusionOur systematic review shows gross underestimation of the true leptospirosis burden in the national statistics of Sri Lanka, and the hospitalization rates estimated in our study were compatible with the total burden estimate of 300·6 (95% CI 96·54–604·23) per 100,000 people published previously.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3655-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Estimating the burden of leptospirosis in Sri Lanka; a systematic review

2019

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“…Moreover, in one study, mortality was higher in adults than pediatrics and old age was independent risk factor for death within adults [39]. In another study, old age patients were more in need for dialysis (LOPES et al, 2004, Weeratunga et al, 2015 which was associated with the mortality in those patients. Moreover, Lopes, Costa [61] showed the mean age of their cohort was signi cantly higher in patients with hyperkalemia which was signi cantly associated with mortality.…”

Section: Discussionmentioning

confidence: 94%

Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in Peninsular Malaysia: A cross sectional retrospective analysis

Hariri¹,

Sulaiman²,

Khan³

et al. 2021

Preprint

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Objectives Leptospirosis is the most common anthropozoonosis worldwide and imposes a major public health problem in many tropical countries. It is a leading cause of disease burden in form of mortality, morbidity and hospital admission. Identifying patients at high risk for mortality or for prolonged hospitalization may save lives and preserve economy. The aim of the current study was to identify significant factors associated with disease mortality and prolonged hospitalization.Design Cress-sectional retrospective studySettings Tertiary care teaching hospitals in Kelantan, Peninsular Malaysia Participants Adult patients proven to have leptospirosis depending on IgM ELISA were classified into two classes depending on prolonged hospitalization (>7 days or ≤ 7 days) and mortality (fatal cases or non-fatal cases). Patients’ clinico-laboratory data were compared according to these two outcomes using the appropriate statistical test accordingly.Results Of the 525 patients enrolled, 136 (25.9%) had prolonged hospitalization. The mean length of stay was 6.77 ± 5.68 days. Logistic regression analysis identified acute kidney injury (AKI) (OR 2.3), Jaundice (OR 2.7), elevated alanine aminotransferase (ALT) (OR 2), and prolonged prothrombin time (PT) (OR 1.9) independently associated with prolonged hospitalization. Case fatality rate was 6.48% and around one third of fatal cases had prolonged hospitalization of more than seven days. Factors associated with leptospirosis mortality included age > 40 years (p<0.001), patients presented with tachypnea (p=0.002), pulmonary infiltrate (p<0.001), T-wave changes (p<0.001), atrial fibrillation (p=0.013), conducting abnormality (p<0.001), chronic kidney diseases (p<0.001), multiple organ dysfunctions (p<0.0010), respiratory failure (p<0.001), pneumonia (p<0.001), sepsis (p=0.004), low venous PH (p=0.042), AKI (P<0.001), elevated AST (p<0.001) or ALT (p=0.004), hypoalbuminemia (p<0.001), rhabdomyolysis (p<0.001), severe thrombocytopenia (p=0.042), prolonged PT (p<0.001) or prolonged aPTT (p<0.017).Conclusions Significant proportion of leptospirosis patients (25.9%) had prolonged hospital stay and less proportion died (6.48%). Early identifying patients with factors associated with prolonged hospitalization and death will positively impact practitioners’ decisions regarding the proper and fast course of management including ICU admission

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“…Leptospirosis is one of the most common causes of sepsis, especially in the tropics [ 2 ], including Thailand [ 4 ]. Severe leptospirosis usually requires ICU admission, which can account for 30% of the hospitalised leptospirosis patients [ 5 ], where mortality in these patients may be as high as 40% [ 6 ]. In this study, 24% of the severe leptospirosis participants were admitted to ICU and the overall mortality rate of these severe patients was 21%.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly 30% of severe, leptospirosis infections are severe and these patients usually require intensive care unit (ICU) admission [5][6][7][8], with a mortality rate as high as 40% [6]. These patients often developed kidney failure, liver failure, or cardiopulmonary failure, and required high level of care.…”

Section: Introductionmentioning

confidence: 99%

Circulating microtranscriptome profiles reveal distinct expression of microRNAs in severe leptospirosis

et al. 2020

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Biomarkers to predict the severity of leptospirosis are still lacking. This study aimed to identify and validate microRNAs in patients with severe leptospirosis, that could potentially be used as biomarkers for predicting an unfavorable outcome. Serum samples were collected from participants with definite diagnosis of leptospirosis. The participants were divided into two groups, non-severe and severe leptospirosis, as defined by the Specific Organ Sequential Organ Failure (SOFA) Score of more than two in any organ. Microtranscriptome analysis was performed using the NanoString miRNA Expression Assay. The expression level of candidate miRNAs was then validated by quantitative RT-PCR. Based on the NanoString, the microtranscriptome profile of the severe group was significantly different from that of the non-severe group. Upregulation of miR155-5p, miR362-3p, miR502-5p, miR601, miR1323, and miR630 in the severe group were identified, and further investigated. A total of 119 participants were enrolled in the validation cohort. Serum miR155-5p and miR630 levels were significantly higher in the severe group compared to the non-severe group. The combined use of miR155-5p or miR-630 with serum bicarbonate levels had an AUC of 0.79 (95%CI; 0.69–0.89, p<0.001) in identifying the severity of the disease. This data provides the first evidence that the microtranscriptome profiles of patients with severe leptospirosis were different from the non-severe group. Serum miR155-5p and miR630 levels might be novel biomarkers for identifying severe leptospirosis.

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Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital – a three year retrospective study

Cited by 12 publications

References 40 publications

Estimating the burden of leptospirosis in Sri Lanka; a systematic review

Estimating the burden of leptospirosis in Sri Lanka; a systematic review

Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in Peninsular Malaysia: A cross sectional retrospective analysis

Circulating microtranscriptome profiles reveal distinct expression of microRNAs in severe leptospirosis

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