Predictors of Severe Leptospirosis: A Multicentre Observational Study From Central Malaysia

Abstract

Background: Leptospirosis is a re-emerging disease with vast clinical presentations ranges from subclinical or mild, to severe and fatal outcomes. Though leptospirosis can be managed well if diagnosed earlier, similar clinical presentations by several other febrile illnesses or co-infections often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study. Methods: Data were collected from case records of 83 confirmed leptospirosis patients comprising of 33 severe and 50 mild. Statistical analysis was performed using χ2 and multivariable logistic regression test with Epi info software. Results: We identified mechanical ventilation, AKI, septic shock, creatinine level of >1.13mg/dL, ALT >50IU, AST >50IU, and platelet <150 x 109/L as factors associated with severe illness. AKI, ALT >50IU and platelet <150 x 109/L were defined as the independent factors for severity. Conclusions: Lungs, liver and kidney involvement, and septic shock were found as the prognostic factors for severe leptospirosis. AKI, high level of ALT and low level of platelets were found to be independent predictors of severity.