title: Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study.
abstract: BACKGROUND
  Leptospirosis results in significant morbidity and mortality. This study elucidates markers of severity in a cohort of Sri Lankan patients.
  
  
  METHODS
  Patients presenting to three healthcare institutions in the Western province of Sri Lanka with leptospirosis serological confirmed by the microscopic agglutination test (MAT) were included. Prospective data regarding demographic, clinical and laboratory parameters was extracted. Univariate associations and subsequent multivariate logistic regression models were constructed.
  
  
  RESULTS
  The study included 232 patients, with 68.5% (159) demonstrating severe disease. Significant associations of severe disease at a significance level of p<0.05 were fever >38.8°C on presentation, age >40 years, muscle tenderness, tachycardia on admission, highest white cell count >12 350/mm(3) and <7900/mm(3), highest neutrophil percentage >84%, haemoglobin >11.2 g/dL and <10.2 g/dL, packed cell volume (PCV) >33.8% and <29.8%, lowest platelet count <63 500/mm(3), highest alanine transaminase (ALT) >70 IU/L and hyponatremia with sodium <131 mEq/L. On multivariate analysis, PCV <29.8% (p=0.011; OR 3.750; CI: 1.394-10.423), ALT >70 IU/L (p=0.044; OR 2.639; CI: 1.028-6.774) and hyponatremia <131 mEq/L (p=0.019; OR 6.413; CI: 1.353-30.388) were independent associations of severe disease.
  
  
  CONCLUSIONS
  Severity associations were demonstrated with both clinical and laboratory parameters. There is a need for novel biomarkers for prediction of severity in leptospirosis.
authors.affiliation: Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Senaka
authors.initials: S
authors.lastname: Rajapakse
authors.affiliation: Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka prav782@yahoo.com.
authors.forename: Praveen
authors.initials: P
authors.lastname: Weeratunga
authors.affiliation: Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka.
authors.forename: M J Roshan
authors.initials: MJ
authors.lastname: Niloofa
authors.affiliation: Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka.
authors.forename: Narmada
authors.initials: N
authors.lastname: Fernando
authors.affiliation: Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Chathuraka
authors.initials: C
authors.lastname: Rodrigo
authors.affiliation: Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Sachith
authors.initials: S
authors.lastname: Maduranga
authors.affiliation: Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Nipun Lakshitha
authors.initials: NL
authors.lastname: de Silva
authors.affiliation: Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.
authors.forename: Nipun Lakshitha
authors.initials: NL
authors.lastname: Fernando
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
authors.affiliation: Department of Bacteriology, Medical Research Institute, Colombo 08, Sri Lanka.
authors.forename: Lilani
authors.initials: L
authors.lastname: Karunanayake
authors.affiliation: Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo 03, Sri Lanka.
authors.forename: Shiroma
authors.initials: S
authors.lastname: Handunnetti
mesh_terms: D000328:Adult; D000372:Agglutination Tests; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D019411:Clinical Laboratory Techniques; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D005798:Genes, Bacterial; D006801:Humans; D007919:Leptospira / Q000302:isolation & purification*; D007922:Leptospirosis / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013188:Sri Lanka / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers
keywords: Leptospirosis; Severity; Sri Lanka