head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2022, vol. 28, issue2
Subject Area: Medicine
DOI: 10.5272/jimab.2022282.4423
Published online: 23 June 2022

Original article
J of IMAB. 2022 Apr-Jun;28(2):4423-4430
Galya GanchevaORCID logo Corresponding Autoremail,
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine, Faculty of Public Health, Medical University – Pleven, Bulgaria.

The case-fatality rate of leptospirosis rises above 50% if intensive treatment is delayed. Our purpose was to create a simple score that could be used quickly to identify patients at the greatest risk.
Material and Methods: One hundred consecutive patients with leptospirosis treated in the Clinic of Infectious Diseases at University Hospital “Dr Georgi Stranski” - Pleven (1976-2018) were distributed retrospectively in groups with a non-severe and severe course (66 and 34, respectively). The once interesting prognosis was an eventual risk for the severe course. Data were analyzed using statistical software (IВМ SPSS Statistics 19.0).   
Results: The multivariate analysis identified seven variables independent associated with severe course: age ≥60 years OR (95% CI):15.45 (12.21–19.7), hospital admission >4 days after the clinical onset OR (95% CI):4.18 (2.23–7.86; oligo/anuria OR (95% CI):10.95 (3.2–19.8); hypotension OR (95% CI):13.936 (6.5–19.9); pulmonary findings OR (95% CI):25.45 (17.5–32.4); arrhythmia OR (95% CI):15.5 (10.2–19.6), and hemorrhages OR (95% CI):21.6 (18.3– 29.7). The mentioned variables (awarded one point each) were used to generate a seven-point prognostic score. The risk for severe course increased incrementally. A score of two, three, four or five had a positive predictive value of 30%, 38%, 74% and 89%, respectively (95% CI:28–39, 32–43, 60 – 90, 70–92, respectively). A score of six or seven had a positive predictive value of 100% (95% CI: 96–100 and 98–100, respectively).
Conclusion: A simple seven-point clinical based prognostic score would help clinicians identify people at risk of severe leptospirosis and initiate prompt intensive treatment, including hemodialysis.

Keywords: leptospirosis, prognosis, score,

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Please cite this article as: Gancheva G. Prognostic score for severity of leptospirosis. J of IMAB. 2022 Jan-Mar;28(1):4423-4430. DOI: 10.5272/jimab.2022282.4423

Corresponding AutorCorrespondence to: Galya Ivanova Gancheva, Clinic of Infectious Diseases, University Hospital, Medical University Pleven; 8A “Georgi Kochev” Str., Pleven 5800, Bulgaria; E-mail: galya_gancheva@abv.bg

1. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015 Sep 17; 9(9): e0003898. [PubMed]
2. Hartskeerl RA, Collares-Pereira M, Ellis WA. Emergence, control and re-emerging leptospirosis: dynamics of infection in the changing world. Clin Microbiol Infect. 2011 Apr;17(4):494-501. [PubMed]
3. Delmas B, Jabot J, Chanareille P, Ferdynus C, Allyn J, Allou N, et al. Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions. Crit Care Med. 2018 Jan;46(1):93-99. [PubMed]
4. Chawla V, Trivedi TH, Yeolekar ME. Epidemic of leptospirosis: an ICU experience. JAPI. 2004 Aug;52:619-22. [PubMed]
5. Rajapakse S, Rodrigo C, Haniffa R. Developing a clinically relevant classification to predict mortality in severe leptospirosis. J Emerg Trauma Shock. 2010 Jul; 3(3):213-9. [PubMed]
6. Tubiana S, Mikulski M, Becam J, Lacassin F, Lefevre P, Gourinat AC, et al. Risk factors and predictors of severe leptospirosis in New Caledonia. PLoS Negl Trop Dis. 2013;7(1):e1991. [PubMed]
7. Lee N, Kitashoji E, Koizumi N, Lacuesta TLV, Ribo MR, Dimaano EM, et al. Building prognostic models for adverse outcomes in a prospective cohort of hospitalized patients with acute leptospirosis infection in the Philippines. Trans R Soc Trop Med Hyg. 2017 Dec 1;111(12):531-9. [PubMed]
8. Marotto PC, Ko AI, Murta-Nascimento C, Seguro AC, Prado RR, Barbosa MC, et al. Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model. J Infect. 2010 Mar;60(3):218-23. [PubMed]
9. Hochedez P, Theodose R, Olive C, Bourhy P, Hurtrel G, Vignier N, et al. Factors Associated with Severe Leptospirosis, Martinique, 2010-2013. Emerg Infect Dis. 2015 Dec;21(12):2221-4. [PubMed]
10. Mohd Radi MF, Hashim JH, Jaafar MH, Hod R, Ahmad N, Mohammed Nawi A, et al. Leptospirosis Outbreak after the 2014 Major Flooding Event in Kelantan, Malaysia: A Spatial-Temporal Analysis. Am J Trop Med Hyg. 2018 May;98(5):1281-1295. [PubMed]
11. Shafei MN, Zainuddin MA, Yaacob NA, Mohammad ZW, Awang N, Hassan SA, et al. Occupational Risk Factors for Seropositive Leptospirosis among Town Service Workers in Northeastern Malaysia. BJMS. 2022 Jan;16(1):31-42. [Crossref]
12. Gancheva G. [Complex studies on leptospirosis]. [PhD dissertation] Medical University – Pleven, Bulgaria. 2006: pp.72-73. [in Bulgarian] 13. Galan DI, Roess AA, Pereira SVC, Schneider MC. Epidemiology of human leptospirosis in urban and rural areas of Brazil, 2000-2015. PLoS One 2021 Mar 4:16(3):e0247763. [PubMed]
14. Cetin BD, Harmankaya O, Hasman H, Gunduz A, Oktar M, Seber E. Acute renal failure: a common manifestation of leptospirosis. Ren Failure. 2004 Nov; 26(6):655-61. [PubMed]
15. Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Daijardin JB. Leptospirosis: prognostic factors associated with mortality. Clin Infect Dis. 1997 Sep; 25(3):720-4. [PubMed]
16. Spichler AS, Vilaca PJ, Athanazio DA, Albuquerque JO, Buzzar M, Castro B, et al. Predictors of lethality in severe leptospirosis in urban Brazil. Am J Trop Med Hyg. 2008 Dec;79(6):911-4. [PubMed]
17. Vasava A, Sharma AK. A Descriptive Study on Prevalence and Outcome of Human Leptospirosis Case with Various Co-infections at Tertiary Care Hospital, South Gujarat. Int J Res Med. 2017; 6(4):1-5. [Internet]   
18. Budiono E, Sumardi, Riyanto BS, Hisyam B, Hartopo AB. Pulmonary involvement predicts mortality in severe leptospirosis patients. Acta Med Indones. 2009 Jan; 41(1):11-4. [PubMed]
19. Papa A, Theoharidou D, Antoniadis A. Pulmonary involvement and leptospirosis, Greece. Emerg Infectious Dis. 2009 May;15(5):834-5. [PubMed]
20. Panaphut T, Domrongkitchaiporn S, Thinkamrop B. Prognostic factors of death in leptospirosis: a prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis. 2002 Mar;6(1):52-9. [Crossref]
21. Al Hariri YK, Sulaiman SAS, Khan AH, Adnan AS, Al Ebrahem SQ. Mortality of leptospirosis associated acute kidney injury (LAKI) & predictors for its development in adults: A systematic review. J Infect Public Health. 2019 Nov-Dec; 2(6):751-759. [PubMed]
22. Yang CW. Leptospirosis renal disease: understanding the initiation by Toll-like receptors. Kidney Int. 2007 Oct;72(8):918-25. [PubMed]
23. Yamaguchi T, Higa N, Okura N, Matsumoto A, Hermawan I, Yamashiro T, et al. Characterizing interactions of Leptospira interrogans with proximal renal tubule epithelial cells. BMC Microbiol. 2018 Jul;18(1):64. [PubMed]
24. Segura ER, Ganoza CA, Campos K, Ricaldi JN, Torres S, Silva H, et al. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis. 2005 Feb; 40(3):343-51. [PubMed]
25. Leedahl DD, Frazee EN, Schramm GE, Dierkhising RA, Bergstralh EJ, Chawla LS, et al. Derivation of urine output thresholds that identify a very high risk of AKI in patients with septic shock. Clin J Am Soc Nephrol. 2014 Jul;9(7):1168-74. [PubMed]
26. Rista E, Puca E, Cadri V, Saliaj K, Akshija I, Duraku A, et al. Acute kidney injury in leptospirosis: A country-level report. Travel Med Infect Dis. 2022 Jun 2,49:102359. [PubMed]
27. Sitprija V. Renal dysfunction in leptospirosis: a view from the tropics. Nat Clin Pract Nephrol. 2006 Dec; 2(12):658-9. [PubMed]
28. Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CR. Leptospiral pneumonias. Curr Opin Pulm Med. 2007 May;13(3):230-5. [PubMed]
29. Andrade L, Rodrigues AC Jr., Sanches TR, Souza RB, Seguro AC. Leptospirosis leads to dysregulation of sodium transporters in the kidney and lung. Am J Physiol Renal Physiol. 2007 Feb;292(2):F586-92. [PubMed]
30. Sartori C, Matthay MA. Alveolar epithelial fluid transport in acute lung injury: new insights. Eur Respir J. 2002 Nov;20(5):1299-313. [PubMed]
31. Van Hooste WLC. Leptospirose bij een geriatrische patiënt: een aantal kanttekeningen. Tijdschrift voor Geneeskunde. 2021 Jan;2(1).  [Crossref]
32. Bertels A, Mertens V, Moorkens G, Jansens H, Vlieghe E. Leptospirose bij een geriatrische patiënt. Tijdschr voor Geneeskunde. 2020; 76(18):906-911.
33. Prisacariu A, Fastenaekels M, Jobe J. Leptospirose sévère compliquée d’un choc septique: à propos d’un cas. A case of leptospirosis complicated by septic shock. J Eur Urgences Reanim. 2021 Oct;33(3):173-7. [Crossref]  
34. De Brito T, Aiello VD, da Silva LF, Goncalves da Silva AM, Ferreira da Silva WL, Castelli JB, et al. Human hemorrhagic pulmonary leptospirosis: pathological findings and pathophysiological correlations. PloS one. 2013 Aug;8(8):e71743. [PubMed]
35. Levett PN. Leptospirosis. Clin microbiol rev. 2001 Apr;14(2):296-326. [PubMed]
36. Daher EF, Silva GB Jr., Karbage NN, Carvalho PC Jr., Kataoka RS, Silva EC, et al. Predictors of oliguric acute kidney injury in leptospirosis. A retrospective study on 196 consecutive patients. Nephron Clin Pract. 2009; 112(1):c25-30. [PubMed]
37. Daher EF, Soares DS, Galdino GS, Macedo КS, Gomes PEAC, Pires Neto RDJ, Silva Junior GBD. Leptospirosis in the elderly: the role of age as a predictor of poor outcomes in hospitalized patients. Pathog Glob Health. 2019 May:113(3):117-123. [PubMed]
38. Covic A, Goldsmith DJ, Gusbeth-Tatomir P, Seica A, Covic M. A retrospective 5-year study in Moldova of acute renal failure due to leptospirosis: 58 cases and a review of the literature. Nephrol, Dial, Transplant. 2003 Jun;18(6):1128-34. [PubMed]
39. Pertuiset E, Fen Chong M, Duval G, Genin R. Clinical aspects and prognostic factors of icterohemorrhagic leptospirosis in adults. Apropos of 249 cases in La Reunion. Rev Med Interne. 1988 Nov-Dec;9(5):487-93. [PubMed]
40. Doudier B, Garcia S, Quennee V, Jarno P, Brouqui P. Prognostic factors associated with severe leptospirosis. Clin microbiol and infect. 2006 Apr;12(4):299-300. [PubMed].

Received: 18 December 2021
Published online: 23 June 2022

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