Abstract
Background: Weil's syndrome — the combination of jaundice, renal dysfunction and haemorrhagic diathesis — represents the most severe phenotype of leptospirosis, but its incidence and outcome relative to non-icteric disease are not well characterised in Indian tertiary-care cohorts.
Methods: In this prospective, single-centre observational study conducted over 24 months (2018–2020), 85 patients aged 18–70 years with leptospirosis diagnosed by modified Faine's criteria were enrolled. Weil's syndrome was defined clinically and biochemically as the combination of jaundice, renal dysfunction and bleeding diathesis, and was related to coagulation parameters, site of bleeding and in-hospital outcome using Fisher's exact test.
Results: Weil's syndrome was present in 21 of 85 patients (24.7%). In-hospital mortality was 57.1% (12/21; 95% confidence interval [CI] 36.5–75.5) with Weil's syndrome against 17.2% (11/64; 95% CI 9.9–28.2) without — a risk ratio of 3.3 and an odds ratio of 6.25 (95% CI 1.91–21.72; p=0.001). Although affecting only a quarter of the cohort, Weil's syndrome accounted for 12 of the 23 deaths (52.2%). Among the 37 patients with bleeding, the syndrome was most frequent with petechiae (13/15, 86.7%) and haemoptysis (7/9, 77.8%). Disseminated intravascular coagulation (DIC) was identified in 23 patients (27.1%); every patient who died with DIC also had Weil's syndrome.
Conclusion: Weil's syndrome affected roughly one in four patients but accounted for over half of all deaths. Its close overlap with DIC and with severe bleeding suggests that recognition of the icteric–renal–haemorrhagic triad should prompt immediate escalation of monitoring and supportive care.
Keywords: Leptospirosis, Weil's syndrome, icterohaemorrhagic, disseminated intravascular coagulation, Mortality