Predictors of the development of myocarditis or acute renal failure in patients with leptospirosis: An observational study

Abstract

BackgroundLeptospirosis has a varied clinical presentation with complications like myocarditis and acute renal failure. There are many predictors of severity and mortality including clinical and laboratory parameters. Early detection and treatment can reduce complications. Therefore recognizing the early predictors of the complications of leptospirosis is important in patient management. This study was aimed at determining the clinical and laboratory predictors of myocarditis or acute renal failure.MethodsThis was a prospective descriptive study carried out in the Teaching Hospital, Kandy, from 1st July 2007 to 31st July 2008. Patients with clinical features compatible with leptospirosis case definition were confirmed using the Microscopic Agglutination Test (MAT). Clinical features and laboratory measures done on admission were recorded. Patients were observed for the development of acute renal failure or myocarditis. Chi-square statistics, Fisher's exact test and Mann-Whitney U test were used to compare patients with and without complications. A logistic regression model was used to select final predictor variables.ResultsSixty two confirmed leptospirosis patients were included in the study. Seven patients (11.3%) developed acute renal failure and five (8.1%) developed myocarditis while three (4.8%) had both acute renal failure and myocarditis. Conjunctival suffusion - 40 (64.5%), muscle tenderness - 28 (45.1%), oliguria - 20 (32.2%), jaundice - 12 (19.3%), hepatomegaly - 10 (16.1%), arrhythmias (irregular radial pulse) - 8 (12.9%), chest pain - 6 (9.7%), bleeding - 5 (8.1%), and shortness of breath (SOB) 4 (6.4%) were the common clinical features present among the patients. Out of these, only oliguria {odds ratio (OR) = 4.14 and 95% confidence interval (CI) 1.003-17.261}, jaundice (OR = 5.13 and 95% CI 1.149-28.003), and arrhythmias (OR = 5.774 and 95% CI 1.001-34.692), were predictors of myocarditis or acute renal failure and none of the laboratory measures could predict the two complications.ConclusionsThis study shows that out of clinical and laboratory variables, only oliguria, jaundice and arrhythmia are strong predictors of development of acute renal failure or myocarditis in patients with leptospirosis presented to Teaching Hospital of Kandy, Sri Lanka.

Comparative Analysis of Pediatric and Adult Leptospirosis in Pleven Region, Bulgaria

“…We consider that when ARF is presented, leptospirosis is a serious infection with severe multi-systemic organ involvement and ultimately failure. In the absence of ARF, death due to leptospirosis is very uncommon, but the reported mortality due to leptospirosis with ARF is high: 36% in Barbados [1], 26% in Sri Lanka [8], and 17% in Turkey [21]. In our study 31% of children cases had oliguria vs. 62% of adults (p<0.025) but only 15% of children had ARF vs. 67% of adults (p<0.0005).…”

“…Evidence of myocardial involvement was detected in 10% of 80 severe icteric cases in Louisiana [1], while in India and Sri Lanka -in over 40% of patients [7,8,[26][27][28]. Arrhythmias were predictors of myocarditis (OR 5.774) in severe leptospirosis cases in Sri Lanka [8], and in Brazilian series (OR 2.83) [9]. Repolarization abnormalities on ECG were considered a poor prognostic indicator (OR 5.9) in severe leptospirosis cases.…”

“…Worldwide, independent prognostic factors for lethal outcome in leptospirosis have been found to include older age, oliguria, hyperkalemia, abnormal serum creatinine, acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, elevated bilirubin, hypotension, arrhythmia, and altered mental status [5][6][7][8][9]. However, such studies have typically been hospital-, not population-based.…”

An infectious cause of acute kidney injury with low serum potassium

“…Weil's disease is the most severe form of this illness and leads to jaundice, renal failure and haemorrhage with reported mortality rates up to 20%. Patients presenting with poor prognostic factors such as hypotension, dyspnoea, oliguria, hyperkalaemia, thrombocytopenia, repolarisation abnormalities on ECG and alveolar infiltrates should be treated in an intensive care unit 7 8. Notably, young healthy patients can also succumb in case of severe leptospirosis.…”

Infectious Diseases and the Kidney

“…Advanced age, alcohol abuse, oliguria, presence of arrhythmias and jaundice have been shown to be predictors of severe leptospirosis infection [ 10 ], but even the young and fi t can succumb. For those who survive, good renal recovery is the norm.…”