Does leptospirosis behave adversely in cirrhosis of the liver?

Arumugam, Somasundaram; Loganathan, N; Varghese, Joy; Singh, Shivakumar; Venkataraman, Jayanthi

doi:10.1007/s12664-014-0500-0

Cited by 4 publications

(9 citation statements)

References 16 publications

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“…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: Discussionsupporting

confidence: 91%

“…7,24 The mean serum bilirubin level was significantly higher in patients with underlying cirrhosis compared to those without cirrhosis, similar to previous studies. 15 The mean serum transaminases values in our study were similar to that reported by Sethi et al 7 but higher than those reported by Clerke et al [40-50 U/L]. 24 The magnitude of AST and ALT rise was higher in noncirrhotics compared to cirrhotics.…”

Section: Discussionsupporting

confidence: 85%

“…4 Early occurrence of complications such as hepatitis mandates caution in the primary care setting. 15 Our study describes in detail, the hepatic manifestations of leptospirosis, and compares the differences in presentation and outcome of leptospirosis in patients with and without underlying liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, renal involvement was found to be more common among cirrhotics in another study. 15 Izurieta et al have reported that the risk of developing renal failure increases with the increasing severity of jaundice. 4 Pulmonary involvement in leptospirosis is well documented, and has been reported in up to 37% patients.…”

Section: Discussionmentioning

confidence: 99%

“…Very few studies have focussed on hepatic dysfunction in leptospirosis, and only a single study has evaluated the effect of leptospira infection in patients with pre-existing liver cirrhosis. [15][16] Cases of acute liver failure due to leptospirosis have also been reported. [17][18] This study aimed to analyse the hepatic dysfunction due to leptospirosis in both cirrhotic and non-cirrhotic patients, and to find the predictors of mortality in these patients.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Goyal

2016

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EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure

Wendon¹,

Córdoba²,

Dhawan³

et al. 2017

Journal of Hepatology

632

466

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Acute liver failure in adults

Лукашик¹,

Karpov²

2019

CMAC

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Ключевые слова: острая печеноч ная недостаточность, поражение печени, осложнения, терапия. В статье систематизирована информация об этиологии, эпидемиологии и клинических проявлениях острой печеночной недостаточности. Приведены статистические данные о частоте ее встречаемо сти при разных нозологических формах, описаны наиболее часто развивающиеся осложнения, из ложены основные подходы к терапии. Цель обзора-обобщить имеющиеся данные и улучшить ос ведомленность врачей об острой печеночной недостаточности.

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Does leptospirosis behave adversely in cirrhosis of the liver?

Abstract: Leptospirosis should be considered as yet another important cause of acute-on-chronic liver failure in endemic areas associated with poor outcome. Death is often due to hepatorenal dysfunction.

Cited by 4 publications

References 16 publications

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

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

EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure

Acute liver failure in adults

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