title: Risk factors for intensive care unit admission in patients with severe leptospirosis: a comparative study according to patients' severity.
abstract: BACKGROUND
  The aim of this study is to investigate predictive factors for intensive care unit (ICU) admission among patients with severe leptospirosis.
  
  
  METHODS
  This is a retrospective study with all patients with severe leptospirosis admitted to a tertiary hospital. Patients were divided in ICU and ward groups. Demographical, clinical and laboratory data of the groups were compared as well as acute kidney injury (AKI) severity, according to the RIFLE criteria (R = Risk, I = Injury, F = Failure, L = Loss, E = End-stage kidney disease).
  
  
  RESULTS
  A total of 206 patients were included, 83 admitted to ICU and 123 to ward. Mean age was 36 ± 15.8 years, with 85.9% males. Patients in ICU group were older (38.8 ± 15.7 vs. 34.16 ± 15.9 years, p = 0.037), had a shorter hospital stay (4.13 ± 3.1 vs. 9.5 ± 5.2 days, p = 0.0001), lower levels of hematocrit (29.6 ± 6.4 vs. 33.1 ± 8.6%, p = 0.003), hemoglobin (10.2 ± 2.4 vs. 11.6 ± 1.9 g/dL, p < 0.0001), and platelets (94,427 ± 86,743 vs. 128,896 ± 137,017/mm(3), p = 0.035), as well as higher levels of bilirubin (15.0 ± 12.2 vs. 8.6 ± 9.5 mg/dL, p = 0.001). ICU group also had a higher frequency of severe AKI (RIFLE-"Failure": 73.2% vs. 54.2%, p < 0.0001) and a higher prevalence of dialysis requirement (57.3% vs. 27.6%, p < 0.0001). Mortality was higher among ICU patients (23.5% vs. 5.7%, p < 0.0001). Independent predictors for ICU admission were tachypnea (p = 0.027, OR = 13, CI = 1.3-132), hypotension (p = 0.009, OR = 5.27, CI = 1.5-18) and AKI (p = 0.029, OR = 14, CI = 1.3-150). Ceftriaxone use was a protective factor (p = 0.001, OR = 0.13, CI = 0.04-0.4).
  
  
  CONCLUSIONS
  Independent risk factors for ICU admission in leptospirosis include tachypnea, hypotension and AKI. Ceftriaxone was a protective factor for ICU admission, suggesting that its use may prevent severe forms of the disease.
authors.affiliation: Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. ef.daher@uol.com.br.|Medical Sciences Graduate Program, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. ef.daher@uol.com.br.
authors.forename: Elizabeth De Francesco
authors.initials: Ede F
authors.lastname: Daher
authors.affiliation: Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. douglas.sousa.soares@gmail.com.
authors.forename: Douglas Sousa
authors.initials: DS
authors.lastname: Soares
authors.affiliation: Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. annabmf@hotmail.com.
authors.forename: Anna Tereza Bezerra
authors.initials: AT
authors.lastname: de Menezes Fernandes
authors.affiliation: Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. marilia339@hotmail.com.
authors.forename: Marília Maria Vasconcelos
authors.initials: MM
authors.lastname: Girão
authors.affiliation: Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. pedrorandal@hotmail.com.
authors.forename: Pedro Randal
authors.initials: PR
authors.lastname: Sidrim
authors.affiliation: Departament of Internal Medicine, School of Medicine, Division of Nephrology, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. eanes@fortalnet.com.br.|Medical Sciences Graduate Program, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP: 60135-270, Brazil. eanes@fortalnet.com.br.
authors.forename: Eanes Delgado Barros
authors.initials: ED
authors.lastname: Pereira
authors.affiliation: Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. natalia.a.rocha@gmail.com.
authors.forename: Natalia Albuquerque
authors.initials: NA
authors.lastname: Rocha
authors.affiliation: Public Health Graduate Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil. geraldobezerrajr@yahoo.com.br.
authors.forename: Geraldo Bezerra
authors.initials: GB
authors.lastname: da Silva
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007362:Intensive Care Units; D007902:Length of Stay; D007922:Leptospirosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone
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