Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease)

Abstract

OBJECTIVE:This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area.METHODS:This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3.RESULTS:A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p = 0.001), epistaxis (5.7% vs. 0.8%, p = 0.033), hematemesis (13% vs. 4.6%, p = 0.006), myalgia (91.5% vs. 84.5%, p = 0.038), hematuria (54.8% vs. 37.6%, p = 0.011), metabolic acidosis (18% vs. 9.2%, p = 0.016) and hypoalbuminemia (17.8% vs. 7.5%, p = 0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p = 0.001) and acute kidney injury (OR: 6.6, p = 0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p = 1.000) or during the hospital stay (12.6% vs. 11.3%, p = 0.748).CONCLUSIONS:Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.

Weil’s disease with haemoptysis and acute respiratory distress syndrome

“…Thrombocytopaenia is a frequent and well-known complication of leptospirosis as it is present in more than half of the patients 35…”

Pediatric Fulminant Leptospirosis Complicated by Pericardial Tamponade, Macrophage Activation Syndrome and Sclerosing Cholangitis

“…In a study, thrombocytopenia was present at the time of admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%) in the total 374 number of leptospirosis patients (8). Thrombocytopenia-associated multiple organ failure which is a thrombotic microangiopathic syndrome an independent risk factor for poor outcome in critical illness.…”

Phagocyte Escape of Leptospira: The Role of TLRs and NLRs

“…Platelet activation and dysfunction have been reported in leptospirosis patients ( 102 , 103 ). In addition, thrombocytopenia is a frequent clinical finding, particularly in severe leptospirosis cases, and is associated with a worse prognosis and occurrence of hemorrhages ( 80 , 104 – 106 ). There is no consensus about the underlying mechanisms of the decrease in platelet numbers during leptospirosis.…”