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. 2019 Feb 13;13(2):e0007205.
doi: 10.1371/journal.pntd.0007205. eCollection 2019 Feb.

A simple score to predict severe leptospirosis

Simon Smith  1   2 , Brendan J Kennedy  3   4 , Alexis Dermedgoglou  1 , Suzanne S Poulgrain  1 , Matthew P Paavola  1 , Tarryn L Minto  1 , Michael Luc  1 , Yu-Hsuan Liu  5 , Josh Hanson  1   6
Affiliations

A simple score to predict severe leptospirosis

Simon Smith et al. PLoS Negl Trop Dis. .

Abstract

Background: The case-fatality rate of severe leptospirosis can exceed 50%. While prompt supportive care can improve survival, predicting those at risk of developing severe disease is challenging, particularly in settings with limited diagnostic support.

Methodology/principal findings: We retrospectively identified all adults with laboratory-confirmed leptospirosis in Far North Queensland, Australia, between January 1998 and May 2016. Clinical, laboratory and radiological findings at presentation were correlated with the patients' subsequent clinical course. Medical records were available in 402 patients; 50 (12%) had severe disease. The presence of oliguria (urine output ≤500 mL/24 hours, odds ratio (OR): 16.4, 95% confidence interval (CI): 6.9-38.8, p<0.001), abnormal auscultatory findings on respiratory examination (OR 11.2 (95% CI: 4.7-26.5, p<0.001) and hypotension (systolic blood pressure ≤100 mmHg, OR 4.3 (95% CI 1.7-10.7, p = 0.002) at presentation independently predicted severe disease. A three-point score (the SPiRO score) was devised using these three clinical variables, with one point awarded for each. A score could be calculated in 392 (98%) patients; the likelihood of severe disease rose incrementally: 8/287 (3%), 14/70 (20%), 18/26 (69%) and 9/9 (100%) for a score of 0, 1, 2 and 3 respectively (p = 0.0001). A SPiRO score <1 had a negative predictive value for severe disease of 97% (95% CI: 95-99%).

Conclusions/significance: A simple, three-point clinical score can help clinicians rapidly identify patients at risk of developing severe leptospirosis, prompting early transfer to referral centres for advanced supportive care. This inexpensive, bedside assessment requires minimal training and may have significant utility in the resource-limited settings which bear the greatest burden of disease.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort diagram illustrating the number of confirmed cases of leptospirosis in Far North Queensland, Australia between 1998 and 2016.
Fig 2
Fig 2. Positive predictive value of developing severe leptospirosis using the three-point SPiRO score calculated at presentation.
See this image and copyright information in PMC

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