title: Predictors of mortality in leptospirosis: an observational study from two hospitals in Kolkata, eastern India.
abstract: BACKGROUND
  Leptospirosis has a mortality rate of 5-20%. Poor prognostic factors are older age; oliguria; elevated potassium, creatinine and/or bilirubin levels; and altered mental status. We conducted this retrospective study to analyse the predictors of mortality among Indian patients with leptospirosis.
  
  
  METHODS
  Clinical, biochemical, demographic and treatment related data (time between onset of symptoms and commencement of leptospira specific antibiotics) of 101 leptospirosis patients were reviewed. Predictors identified by univariate analysis were analysed by multivariable Cox regression for survival analysis.
  
  
  RESULTS
  Prominent clinical features were: fever (101/101, 100%), jaundice (62, 62.4%), vomiting (42, 41.6%), oliguria (35, 34.7%), cough (18, 17.8%) and dyspnoea (10, 10.0%). Common complications were acute kidney injury (22, 21.8%), cardiovascular collapse (13, 12.9%), haemorrhages (10, 10.0%), meningitis (7, 6.9%), acute respiratory distress syndrome and pancreatitis (5, 5.0% each). Seventeen patients died (16.8%). Univariate predictors of mortality were older age, delayed antibiotic therapy, higher bilirubin, aspartate aminotransferase, alkaline phosphatase, leucocyte count and aspartate/alanine aminotransferase ratio (AAR). Only AAR (HR 1.208, 95% CI 1.051-1.388) and number of days the patient was symptomatic before access to specific antibiotic therapy (HR 1.304, 95% CI 1.081-1.574) remained significant predictors after Cox regression.
  
  
  CONCLUSIONS
  Multivariate analysis showed high AAR and delayed antibiotic therapy might be associated with fatality.
authors.affiliation: Department of Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, India rudra.goswami@gmail.com.
authors.forename: Rudra P
authors.initials: RP
authors.lastname: Goswami
authors.affiliation: Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India.
authors.forename: Rama P
authors.initials: RP
authors.lastname: Goswami
authors.affiliation: Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India.
authors.forename: Ayan
authors.initials: A
authors.lastname: Basu
authors.affiliation: Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India.
authors.forename: Santanu Kumar
authors.initials: SK
authors.lastname: Tripathi
authors.affiliation: Geriatric & General (Internal) Medicine, Glan Clwyd Hospital, Rhyl, Wales, LL18 5UJ, UK.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Chakrabarti
authors.affiliation: Geriatric & General (Internal) Medicine, Glan Clwyd Hospital, Rhyl, Wales, LL18 5UJ, UK.
authors.forename: Indrajit
authors.initials: I
authors.lastname: Chattopadhyay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000503:physiopathology; D007022:Hypotension / Q000503:physiopathology; D007194:India / Q000453:epidemiology; D007922:Leptospirosis / Q000150:complications* / Q000382:microbiology / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: Aspartate/alanine aminotransferase ratio (AAR); Early antibiotic therapy; India; Leptospirosis; Mortality; Prognostic factors