Impact of clinical and laboratory findings on prognosis in leptospirosis.
OBJECTIVE
The aim of this study was to evaluate epidemiological, clinical and laboratory features, and risk factors for mortality in leptospirosis.


METHODS
Seventy-two adult leptospirosis cases were reviewed. Categorical clinical and laboratory findings of survivors and non-survivors were assessed by Chi square analysis. Non-categorical findings were assessed by the student t test. Clinical findings and laboratory data with p <0.05 were assessed by stepwise logistic regression analysis for mortality.


RESULTS
Of all patients, mean age was 47.3 +/- 15.7 years, 82% were men and, 51% were farmers. Icterus occurred in 75%, and high fever was seen in 61 of the patients. The most frequently detected serotype was Leptospira icterohaemorrhagiae (30%). Overall mortality rate was 17%. In those non-survivors, altered mental status (p = 0.002), hepatomegaly (p = 0.037), haemorrhage (p = 0.019), ALT level (p = 0.008), AST level (p = 0.02), prolonged prothrombin time (p = 0.02) and increased serum potassium levels (p = 0.004) were seen more frequently than in survivors. Altered mental status (p = 0.01, OR: 8.9, CI 95%: 1.6-50.7) and serum potassium levels at hospital admission (p = 0.01, OR: 4.2, CI 95%: 1.4-13.1) were detected as independent risk factors for mortality.


CONCLUSIONS
Leptospirosis patients with altered mental status and hyperpotassaemia at hospital admission are at high risk for mortality and should be followed up more closely at the intensive care unit.
Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey. sabanes@omu.edu.tr
Saban
S
Esen
Mustafa
M
Sunbul
Hakan
H
Leblebicioglu
Cafer
C
Eroglu
Derya
D
Turan
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000175:diagnosis* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology