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. 2022 Jan 11;7(1):7.
doi: 10.3390/tropicalmed7010007.

A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure

Rizza Antoinette Yap So  1 , Romina A Danguilan  1 , Eric Chua  1 , Mel-Hatra I Arakama  1 , Joann Kathleen B Ginete-Garcia  2 , Joselito R Chavez  2
Affiliations

A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure

Rizza Antoinette Yap So et al. Trop Med Infect Dis. .

Abstract

Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan-Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, p < 0.0001), hemoptysis (OR = 20.73, p < 0.0001), diabetes (OR = 10.21, p < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, p < 0.0001), thrombocytopenia (OR = 3.54, p < 0.0029), and oliguria/anuria (OR = 3.15, p < 0.0108) were significantly associated with pulmonary complications. A scoring index was developed termed THe-RADS score (Thrombocytopenia, Hemoptysis, RRT, Anuria, Diabetes, Shortness of breath). The odds of developing pulmonary complications were 13.90 times higher among patients with a score >2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management.

Keywords: mortality; predictors; pulmonary complications; pulmonary hemorrhage; severe leptospirosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curve.
Figure 2
Figure 2
Scoring tool: THe-RADS score.
Figure 3
Figure 3
Receiver operating curve of scoring index in predicting pulmonary complications.
See this image and copyright information in PMC

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