title: Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases.
abstract: OBJECTIVE
  Analysis of risk factors associated with severity in patients with confirmed leptospirosis.
  
  
  METHODS
  Retrospective study in 147 leptospirosis-confirmed patients at two tertiary nonteaching hospital in Reunion Island.
  
  
  METHODS
  138 men and 9 women, aged 36+/-14 years, 80 in the ICU and 67 in medical wards.
  
  
  RESULTS
  We collected demographic, clinical, biological, and radiographic data and performed univariate and multivariate analysis to examine risk factors associated with admission in ICU and mortality. Pulmonary forms were more frequent (85%) than in previous reports, with 85 cases (65.3%) on abnormal chest radiography. Among the 38 patients who underwent bronchoalveolar lavage at admission 31 (81.5%) had alveolar hemorrhage. Independent factors related to ICU admission were: age over 46[Symbol: see text]years (OR 3.02), creatinine higher than 200[Symbol: see text]mumol/l (6.69), shock (13.87), and acute respiratory failure (20.69). Mortality was 12.9%. The only factor independently related to mortality was need for mechanical ventilation (OR 20.94). Icterohemorrhagiae serogroup was found in 62 cases (42.8%) but was not related to death.
  
  
  CONCLUSIONS
  Pulmonary involvement is a major feature in leptospirosis disease but is not associated with poor outcome. Identification of clinical and laboratory findings on admission may help to better characterize severe cases.
authors.affiliation: Service de Pneumologie et Maladies Infectieuses, GHSR, St. Pierre, Réunion, France. f.paganin@wanadoo.fr
authors.forename: Fabrice
authors.initials: F
authors.lastname: Paganin
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourdin
authors.forename: Cécile
authors.initials: C
authors.lastname: Dalban
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Courtin
authors.forename: Patrice
authors.initials: P
authors.lastname: Poubeau
authors.forename: Gianandrea
authors.initials: G
authors.lastname: Borgherini
authors.forename: Alain
authors.initials: A
authors.lastname: Michault
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Sally
authors.forename: François
authors.initials: F
authors.lastname: Tixier
authors.forename: Robert
authors.initials: R
authors.lastname: Genin
authors.forename: Claude
authors.initials: C
authors.lastname: Arvin-Berod
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017508:Reunion / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index