Leptospirosis in the elderly: the role of age as a predictor of poor outcomes in hospitalized patients

Abstract

Background: The aim of this study was to investigate factors associated with poor outcomes among elderly hospitalized patients with leptospirosis. Methods: This is a retrospective cohort study with leptospirosis patients admitted to three tertiary hospitals in Fortaleza, Brazil, from January 1985 to July 2017. Patients were divided into two groups: elderly (age ≥60 years) and young (age <60 years). A comparison of demographical, clinical and laboratory data, treatment and outcomes was executed in order to investigate differences between groups. Results: A total of 507 hospitalized patients were included, with mean age 38 ± 15 years. Elderly group presented lower incidence of myalgia, vomiting, and dyspnea, as well as, higher medium systolic blood pressure. Elderly also manifested higher frequency of AKI (85.9 vs. 74.7%, p = 0.05), hemodialysis requirement (54.7 vs. 37.0%, p = 0.007) and death (32.8 vs. 12.2%, p < 0.001). In multivariate analysis, age ≥60 years was a predictor of hemodialysis requirement (p = 0.008, OR = 2.049, 95% CI = 1.207-3.477) and death (p < 0.001, OR = 3.520, 95% CI = 1.940-6.386). Conclusion: Leptospirosis in the elderly is associated with less hemodynamic impairment and higher frequency of AKI. Advanced age was also a predictor of poor outcomes, such as hemodialysis requirement and death, mostly due to kidney involvement.

Development and validation of a simple machine learning tool to predict mortality in leptospirosis

“…Daher et al have previously shown that age is a crucial predictor of outcomes. Elderly patients with leptospirosis showed less hemodynamic impairment on admission, higher incidence of AKI (OR 2.049, 95% CI 1.207–3.477), and a higher frequency of death (OR 3.520, 95% CI 1.940–6.386) during hospital stay than younger patients 13 .…”

“…In a prospective observational study, hemoglobin (Hb) levels lower than 11 g/dL were associated with severe forms of the disease (70% versus 14.8%; OR = 16.2 [95% CI 3.9-66.9]) 22 . Another study has shown that Elderly patients with leptospirosis showed less hemodynamic impairment on admission, higher incidence of AKI (OR 2.049, 95% CI 1.207-3.477), and a higher frequency of death (OR 3.520, 95% CI 1.940-6.386) during hospital stay than younger patients 13 .…”

“…In an attempt to improve leptospirosis prognosis, previous studies have investigated risk factors for poor outcomes 6,[11][12][13][14] . However, to the best of our knowledge, only one predictor of outcomes is available, SPIRO.…”

Leptospirosis in Retirees Living in Rural Areas: A Poorly Recognized Emerging Problem in Mainland France?

“…However, this bias alone does not seem sufficient to explain the age difference between our study and previous ones. Such a large proportion of patients age >60 should be of particular interest for clinicians: Older age has been associated with specific misleading clinical aspects: A possible lower incidence of myalgia, vomiting, and dyspnea has been suggested in a Brazilian study [ 11 ]; older age may increase the likelihood of hemodialysis requirement and worsen the prognosis of leptospirosis [ 11 , 12 ].…”

“…Most studies on leptospirosis in the elderly have been performed in Brazil [ 11 , 17 ]. Watrin and colleagues reported that retired patients accounted for a third of leptospirosis cases diagnosed in Normandy (northwestern France) between 2010 and 2014 (unpublished study) [ 18 ].…”