title: Predictors of lethality in severe leptospirosis in urban Brazil.
abstract: To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients' hospitalizations, which were obtained from hospitals representing all sectors of São Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age>40 years, development of oliguria, platelet count<70,000/microL, creatinine>3 mg/dL, and pulmonary involvement. The latter was the strongest risk factor with an estimated odds ratio of 6.0 (95% confidence interval: 3.0-12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in São Paulo, of relevance in leptospirosis-endemic regions where this complication is common.
authors.affiliation: Health Municipality Secretariat of São Paulo, São Paulo, Brazil.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Spichler
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Vilaça
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Athanazio
authors.forename: Jose O M
authors.initials: JO
authors.lastname: Albuquerque
authors.forename: Marcia
authors.initials: M
authors.lastname: Buzzar
authors.forename: Bronislawa
authors.initials: B
authors.lastname: Castro
authors.forename: Antonio
authors.initials: A
authors.lastname: Seguro
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Vinetz
mesh_terms: D000328:Adult; D000375:Aging; D000907:Antibodies, Bacterial; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007922:Leptospirosis / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D008171:Lung Diseases / Q000150:complications / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D051437:Renal Insufficiency / Q000150:complications / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012698:Serologic Tests
chemical_list: D000907:Antibodies, Bacterial; D003404:Creatinine