title: Factors associated with thrombocytopenia in severe leptospirosis (Weil's disease).
abstract: OBJECTIVE
  This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area.
  
  
  METHODS
  This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3.
  
  
  RESULTS
  A total of 374 patients were included, with a mean age of 36.1 ± 15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p=0.001) and acute kidney injury (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during the hospital stay (12.6% vs. 11.3%, p=0.748).
  
  
  CONCLUSIONS
  Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Elizabeth F
authors: EF
authors: Daher
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Geraldo B
authors: GB
authors: Silva
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Charles O
authors: CO
authors: Silveira
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Felipe S
authors: FS
authors: Falcão
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Marília P
authors: MP
authors: Alves
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Jório A A A
authors: JA
authors: Mota
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Joyce B
authors: JB
authors: Lima
authors: Federal University of Ceará, Department of Statistics, FortalezaCE, Brazil, Federal University of Ceará, Department of Statistics, Fortaleza/CE, Brazil.
authors: Rosa M S
authors: RM
authors: Mota
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Ana Patrícia F
authors: AP
authors: Vieira
authors: Federal University of Ceará, Department of Community Health, FortalezaCE, Brazil, Federal University of Ceará, Department of Community Health, Fortaleza/CE, Brazil.
authors: Roberto da Justa
authors: Rda J
authors: Pires
authors: Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
authors: Alexandre B
authors: AB
authors: Libório
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002423:Cause of Death; D002648:Child; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D062606:Tertiary Care Centers; D013921:Thrombocytopenia / Q000209:etiology*; D014895:Weil Disease / Q000150:complications* / Q000401:mortality; D055815:Young Adult