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Severity markers in severe leptospirosis: a cohort study
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Edité par CCSD ; Springer Verlag -
International audience. Purpose: We aimed at evaluating parameters for their value as severity markers in hospitalized leptospirosis patients.Methods: We recruited 47 informed adult consenting patients and assessed a number of clinical, hematological, biochemical and biological variables. Patients were sorted according to severity based on the fatality or the requirement of mechanical ventilation or dialysis; the parameters studied were compared between groups on inclusion and the next day.Results: Beside septic shock presentation, or a high severity score SAPS II, increased lactate, total bilirubin, lipase, and the AST / ALT ratio or a decreased cytokines IL-10 / TNF-a ratio were all significantly associated with severity. The gene expression of the IL-1 receptor antagonist IL-1ra, the IL-1a and the long pentraxin PTX-3 were also transcribed at higher levels in most severe cases. Patients could rapidly improve or deteriorate, highlighting the need of a new assessment the next day.Conclusions: Our results add to the limited body of knowledge about severity markers in leptospirosis. They also suggest that patients should be re-assessed the next day before being possibly discharged from the hospital. Further studies are needed to confirm relevant and reliable prognostic parameters in leptospirosis that would be helpful for triage purpose.
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