Abstract
Background: Bleeding is a recognised complication of severe leptospirosis, but data correlating coagulation parameters with bleeding and outcome remain limited from Indian centres. Methods: In this prospective, single-centre observational study over 24 months (2018–2020), 85 patients aged 18–70 years with leptospirosis diagnosed by modified Faine's criteria were enrolled. Platelet count, international normalised ratio (INR), disseminated intravascular coagulation (DIC) status, bleeding site and outcome were recorded and compared using Fisher's exact and Cochran–Armitage trend tests. Results: Bleeding occurred in 37 of 85 patients (43.5%), most often gastrointestinal (30.6%), then petechiae (17.6%), subconjunctival haemorrhage (12.9%), haemoptysis (10.6%) and oral bleeding (9.4%). Mortality among those who bled was 48.6% against 10.4% in those who did not (odds ratio [OR] 7.92, 95% confidence interval [CI] 2.39–31.48; p<0.001). Thrombocytopenia affected 53 patients (62.4%) but mortality across the four platelet strata was neither monotonic nor significant (p=0.18). By contrast INR showed a steep gradient: mortality was 3.7% at INR ≤1, 24.4% at 1.1–2, 83.3% at 2.1–5 and 100% in the single patient above 5 (p for trend <0.001); deranged INR carried an OR for death of 15.52 (95% CI 2.22–680.44). DIC affected 23 patients (27.1%) with a mortality of 47.8% (OR 3.75, 95% CI 1.19–12.08; p=0.013), and every patient who died with DIC also had Weil's syndrome. Overall mortality was 27.1%. Conclusion: Coagulopathy is common in severe leptospirosis and strongly associated with bleeding and death. INR, not platelet count, showed the clearest dose–response relationship with mortality
Keywords: Leptospirosis, Coagulopathy, Disseminated intravascular coagulation, Thrombocytopenia, INR, Bleeding, Mortality