A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure

• Published in: Tropical medicine and infectious disease Vol. 7; no. 1; p. 7
• Main Authors: So, Rizza Antoinette Yap, Danguilan, Romina A, Chua, Eric, Arakama, Mel-Hatra I, Ginete-Garcia, Joann Kathleen B, Chavez, Joselito R
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 11.01.2022; MDPI
• Subjects: Clinical medicine; Dyspnea; Fatalities; Floods; Heart failure; Hemoptysis; Hemorrhage; Hospitals; Illnesses; Kidney diseases; Laboratories; Leptospirosis; Meningitis; Mortality; Oliguria; Pain; Pancreatitis; Patients; predictors; pulmonary complications; pulmonary hemorrhage; Renal replacement therapy; severe leptospirosis; predictors; mortality; pulmonary hemorrhage; pulmonary complications; severe leptospirosis
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed7010007

Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan-Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, < 0.0001), hemoptysis (OR = 20.73, < 0.0001), diabetes (OR = 10.21, < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, < 0.0001), thrombocytopenia (OR = 3.54, < 0.0029), and oliguria/anuria (OR = 3.15, < 0.0108) were significantly associated with pulmonary complications. A scoring index was developed termed THe-RADS score (Thrombocytopenia, Hemoptysis, RRT, Anuria, Diabetes, Shortness of breath). The odds of developing pulmonary complications were 13.90 times higher among patients with a score >2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management.