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Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia

BACKGROUND: Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. Leptospirosis can be managed well if diagnosed earlier, however, similar clinical presentations by several other febrile illnesses or co-infections,...

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Autores principales: Philip, Noraini, Lung Than, Leslie Thian, Shah, Anim Md, Yuhana, Muhamad Yazli, Sekawi, Zamberi, Neela, Vasantha Kumari
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527767/
https://www.ncbi.nlm.nih.gov/pubmed/34666707
http://dx.doi.org/10.1186/s12879-021-06766-5
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author Philip, Noraini
Lung Than, Leslie Thian
Shah, Anim Md
Yuhana, Muhamad Yazli
Sekawi, Zamberi
Neela, Vasantha Kumari
author_facet Philip, Noraini
Lung Than, Leslie Thian
Shah, Anim Md
Yuhana, Muhamad Yazli
Sekawi, Zamberi
Neela, Vasantha Kumari
author_sort Philip, Noraini
collection PubMed
description BACKGROUND: Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. Leptospirosis can be managed well if diagnosed earlier, however, similar clinical presentations by several other febrile illnesses or co-infections, and laboratory diagnostic challenges due to the biphasic nature of the illness, often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study. METHODS: A prospective multicenter observational study was performed on patients admitted for clinically suspected leptospirosis. Three hospitals namely Hospital Serdang, Hospital Tengku Ampuan Rahimah and Hospital Teluk Intan were included in the study. Among a total of 165 clinically suspected leptospirosis patients, 83 confirmed cases were investigated for clinical predictors for severe illness. Qualitative variables were performed using χ2 and the relationship between mild and severe cases was evaluated using logistic regression. Multivariable logistic regression was used to predict the independent variable for severity. RESULTS: Among the 83 patients, 50 showed mild disease and 33 developed severe illness. The mean age of the patients was 41.92 ± 17.99 and most were males (n = 54, 65.06%). We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of > 1.13 mg/dL, urea > 7 mmol/L, alanine aminotransferase > 50 IU, aspartate aminotransferase > 50 IU, and platelet < 150 × 10(9)/L as factors associated with severe illness. Acute kidney injury, alanine aminotransferase > 50 IU and platelet < 150 × 10(9)/L were defined as the independent factors for severity. CONCLUSIONS: Lungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis. Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity.
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spelling pubmed-85277672021-10-25 Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia Philip, Noraini Lung Than, Leslie Thian Shah, Anim Md Yuhana, Muhamad Yazli Sekawi, Zamberi Neela, Vasantha Kumari BMC Infect Dis Research Article BACKGROUND: Leptospirosis is a re-emerging disease with vast clinical presentations, that ranges from subclinical or mild to severe and fatal outcomes. Leptospirosis can be managed well if diagnosed earlier, however, similar clinical presentations by several other febrile illnesses or co-infections, and laboratory diagnostic challenges due to the biphasic nature of the illness, often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study. METHODS: A prospective multicenter observational study was performed on patients admitted for clinically suspected leptospirosis. Three hospitals namely Hospital Serdang, Hospital Tengku Ampuan Rahimah and Hospital Teluk Intan were included in the study. Among a total of 165 clinically suspected leptospirosis patients, 83 confirmed cases were investigated for clinical predictors for severe illness. Qualitative variables were performed using χ2 and the relationship between mild and severe cases was evaluated using logistic regression. Multivariable logistic regression was used to predict the independent variable for severity. RESULTS: Among the 83 patients, 50 showed mild disease and 33 developed severe illness. The mean age of the patients was 41.92 ± 17.99 and most were males (n = 54, 65.06%). We identified mechanical ventilation, acute kidney injury, septic shock, creatinine level of > 1.13 mg/dL, urea > 7 mmol/L, alanine aminotransferase > 50 IU, aspartate aminotransferase > 50 IU, and platelet < 150 × 10(9)/L as factors associated with severe illness. Acute kidney injury, alanine aminotransferase > 50 IU and platelet < 150 × 10(9)/L were defined as the independent factors for severity. CONCLUSIONS: Lungs, liver and kidney involvement and septic shock were found as the prognostic factors for severe leptospirosis. Acute kidney injury, high level of alanine aminotransferase and low level of platelets were found to be independent predictors of severity. BioMed Central 2021-10-19 /pmc/articles/PMC8527767/ /pubmed/34666707 http://dx.doi.org/10.1186/s12879-021-06766-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Philip, Noraini
Lung Than, Leslie Thian
Shah, Anim Md
Yuhana, Muhamad Yazli
Sekawi, Zamberi
Neela, Vasantha Kumari
Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia
title Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia
title_full Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia
title_fullStr Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia
title_full_unstemmed Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia
title_short Predictors of severe leptospirosis: a multicentre observational study from Central Malaysia
title_sort predictors of severe leptospirosis: a multicentre observational study from central malaysia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527767/
https://www.ncbi.nlm.nih.gov/pubmed/34666707
http://dx.doi.org/10.1186/s12879-021-06766-5
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