MO314: Oliguria as a Strong Predictor of Mortality in Leptospirosis. (3rd May 2022)

• Record Type: Journal Article
• Authors: Rista, Elvana; Cadri, Vilma; Saliaj, Kristi; Akshija, Ilir; Duraku, Ahmet; Puca, Edmond; Abazaj, Erjona; Thereska, Nestor; Harxhi, Arjan
• Is Part Of: Nephrology dialysis transplantation. Volume 37(2022)Supplement 3
• Publication Date: 2022-05-03
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac068.024
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: BACKGROUND AND AIMS: Leptospirosis is an endemic, globally widespread zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. It presents with high clinical variability, with a constellation of symptoms ranging from a mild, nonspecific, self-limiting febrile syndrome to acute liver failure, acute kidney injury, coagulopathy and respiratory involvement. Acute kidney injury (AKI) is a common complication and generally presents as nonoliguric and hypokalemic. The aim of this study was to delineate potential predictors of mortality in Leptospirosis. METHOD: We conducted 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. RESULTS: 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. CONCLUSION: Our 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.