Abstract
Background: Severe leptospirosis involves multiple organ systems, and the relative contribution of each to mortality is not well quantified in Indian 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. Renal, pulmonary, hepatic and neurological complications, and the organ-supportive interventions they required, were related to in-hospital outcome using Fisher's exact test.
Results: In-hospital mortality was 27.1% (23/85). Renal impairment (creatinine >1 mg/dL) affected 73 patients (85.9%); mortality rose across creatinine strata from 8.3% (<1 mg/dL) to 19.2% (1–3) and 57.1% (>3) (p for trend = 0.001). Hypoxia occurred in 36 patients (42.4%), of whom 33 (91.7%) had ARDS. Hepatitis was the commonest complication (45 patients, 52.9%) and was associated with death (42.2% versus 10.0%; odds ratio [OR] 6.43, 95% confidence interval [CI] 1.84–29.11; p=0.001). Neurological events occurred in 10 patients (11.8%) and carried the highest complication-specific mortality (70.0% versus 21.3%; OR 8.32, 95% CI 1.67–55.55; p=0.003). Mortality was far higher again among patients needing organ support: 87.5% of those dialysed (OR 25.4), 90.0% of those requiring inotropes (OR 95.1) and 94.7% of those invasively ventilated (OR 188.8); p≤0.001 for all.
Conclusion: Multi-organ involvement is common in severe leptospirosis. Mortality escalated far more steeply once a complication required active organ support than with the presence of the complication itself. Neurological involvement, though least common, carried the highest complication-specific mortality.
Keywords: Leptospirosis, Acute kidney injury, ARDS, neurological complications, Hepatitis, Multi-organ dysfunction, Mortality