Oliguria as a Strong Predictor of Mortality in Leptospirosis
A prospective, observational, single-center study in the span of 5 years, from 2010 to 2015. Patients enrolled in the study had an age at presentation >14 years and were hospitalized for longer than 24 h with a conclusive diagnosis of Leptospirosis. Baseline patient characteristics, including demographic, clinical and laboratory data were collected. Definitive diagnosis was established through serology assay, using the indirect-ELISA test to detect positive Leptospira IgM and IgG. Fisher's exact test was used to identify predictors of mortality during the course of the infection.

A total of 119 consecutive patients diagnosed with Leptospirosis were enrolled during a 5-year period, 92% were males. Mean age at presentation was 48.8 ± 14.9 and 41.5 ± 19.8 years for males and females, respectively. Mortality in our cohort was estimated to be 9% (10 patients). Urine output and bilirubin levels were found to be the most significant predictors of mortality. Fischer's exact test determined urine output at a cut-off value of 400 mL/24 h as the strongest predictor of mortality (P < 0.001) in Leptospirosis. Bilirubin levels showed an equivalent statistical significance at a cut-off value of 19 mg/dL (P < .001). Creatinine levels on admission, at a cut-off value of 3 mg/dL, proved to be the third strongest predictor of mortality, followed by nadir platelet count and age at a cut-off value of 70 × 103/µL and 49 years, respectively.

The study defined oliguria as the most significant predictor of mortality in patients with severe Leptospirosis, closely followed by bilirubin levels on admission. Other predictors to consider include creatinine levels on admission, nadir platelet count and age at presentation. Incorporating predictors of mortality, from the outset, in treatment algorithms of Leptospirosis, will promote a more timely diagnosis and the development of more specific management guidelines, enabling clinicians to provide personalized treatment plans, potentially impacting the prognosis, morbidity and mortality rates in these patients.

Source: https://academic.oup.com/ndt/article/37/Supplement_3/gfac068.024/6578154?login=true