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Phannajit J, Lertussavavivat T, Limothai U, Tachaboon S, Avihingsanon Y, Praditpornsilpa K, Eiam-Ong S, Tungsanga K, Sitprija V, Srisawat N. Long-term kidney outcomes after leptospirosis: a prospective multicentre cohort study in Thailand. Nephrol Dial Transplant 2023; 38:2182-2191. [PMID: 36746439 DOI: 10.1093/ndt/gfad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Leptospirosis is one of the most important public-health zoonotic diseases in the tropics that can cause severe organ dysfunction and death. Currently there are insufficient data on long-term renal dysfunction in patients after leptospirosis infection. METHODS A prospective multicentre cohort study was conducted at 15 hospitals in the Sisaket province of Thailand. Confirmed leptospirosis patients admitted from 1 December 2015 to 30 November 2018 were followed between 1 February 2020 and 31 October 2020 (median 4.1 years after hospital discharge). The primary outcome was a composite of major kidney adverse events (MAKEs) including all-cause mortality, dialysis and new-onset chronic kidney disease (CKD). RESULTS Of the 217 confirmed leptospirosis cases enrolled, 32.7% were classified as having severe leptospirosis. Fifteen cases (6.9%) were deceased at the time of hospital admission. After a median follow-up time of 4.18 years, 30 patients had died and 33 patients developed CKD. Patients with severe leptospirosis had a significantly higher risk of MAKEs {adjusted hazard ratio 2.45 [95% confidence interval (CI) 1.44-4.18]}. Patients with intensive care unit admission, pulmonary haemorrhage and acute kidney injury also had a higher risk of MAKEs and all-cause mortality. Participants with severe leptospirosis in the follow-up cohort showed a higher risk of developing CKD compared with non-severe leptospirosis [adjusted odds ratio 3.22 (95% CI 1.04-9.96)], especially renal magnesium and phosphate wasting. CONCLUSION Leptospirosis patients, especially severe leptospirosis, are associated with long-term kidney sequelae. Our finding reflects the importance of long-term follow-up and the urgent need for specific interventions.
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Affiliation(s)
- Jeerath Phannajit
- Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanat Lertussavavivat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Umaporn Limothai
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sasipha Tachaboon
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
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Galdino GS, de Sandes-Freitas TV, de Andrade LGM, Adamian CMC, Meneses GC, da Silva Junior GB, de Francesco Daher E. Development and validation of a simple machine learning tool to predict mortality in leptospirosis. Sci Rep 2023; 13:4506. [PMID: 36934135 PMCID: PMC10024714 DOI: 10.1038/s41598-023-31707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/16/2023] [Indexed: 03/20/2023] Open
Abstract
Predicting risk factors for death in leptospirosis is challenging, and identifying high-risk patients is crucial as it might expedite the start of life-saving supportive care. Admission data of 295 leptospirosis patients were enrolled, and a machine-learning approach was used to fit models in a derivation cohort. The comparison of accuracy metrics was performed with two previous models-SPIRO score and quick SOFA score. A Lasso regression analysis was the selected model, demonstrating the best accuracy to predict mortality in leptospirosis [area under the curve (AUC-ROC) = 0.776]. A score-based prediction was carried out with the coefficients of this model and named LeptoScore. Then, to simplify the predictive tool, a new score was built by attributing points to the predictors with importance values higher than 1. The simplified score, named QuickLepto, has five variables (age > 40 years; lethargy; pulmonary symptom; mean arterial pressure < 80 mmHg and hematocrit < 30%) and good predictive accuracy (AUC-ROC = 0.788). LeptoScore and QuickLepto had better accuracy to predict mortality in patients with leptospirosis when compared to SPIRO score (AUC-ROC = 0.500) and quick SOFA score (AUC-ROC = 0.782). The main result is a new scoring system, the QuickLepto, that is a simple and useful tool to predict death in leptospirosis patients at hospital admission.
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Affiliation(s)
- Gabriela Studart Galdino
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil.
- Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Tainá Veras de Sandes-Freitas
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
- Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceara, Brazil
| | | | | | - Gdayllon Cavalcante Meneses
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
| | - Geraldo Bezerra da Silva Junior
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
- Hospital Universitário Walter Cantídio, Federal University of Ceará, Fortaleza, Ceará, Brazil
- School of Medicine, Medical Sciences and Public Health Postgraduate Programs, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Elizabeth de Francesco Daher
- Medical Sciences Postgraduate Program, Federal University of Ceará, Rua Silva Jatahy 1000 ap 600, Fortaleza, Ceará, 60165-070, Brazil
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Meneses GC, de Carvalho Gomes PEA, Galdino GS, Bezerra GF, de Souza Santos RS, Martins AMC, da Silva Junior GB, Libório AB, da Justa Pires Neto R, Daher EDF. Endothelial biomarkers as predictors for hemodialysis need in severe leptospirosis patients (Weil's disease). Trop Med Int Health 2022; 27:727-734. [PMID: 35761507 DOI: 10.1111/tmi.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prediction ability of vascular injury biomarkers for hemodialysis requirement in patients with severe leptospirosis. METHODS Prospective study with severe leptospirosis patients hospitalized in Fortaleza, Brazil. Blood samples were collected at hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to hemodialysis requirement during hospital stay. RESULTS 27 patients were included, with a mean age of 39 ± 18 years. 88.9% were males. 53.8% needed hemodialysis and presented higher levels of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/mL; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/mL; p = 0.01), and FGF-23 (291 [56-2,031] vs. 10 [10-806] pg/mL; p = 0.021). Syndecan-1 showed significant correlation with creatinine (r = 0.546; p = 0.05) and total bilirubin levels (r = 0.534; p = 0.013) at hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r = 0.513; p = 0.009) at hospital admission and the number of hemodialysis sessions (r = 0.406; p = 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict hemodialysis need in patients with severe leptospirosis (AUC-ROC= 0.744 [CI 95%: 0.545 - 0.943] p=0.035). CONCLUSION Syndecan-1 and angiopoietin-2 were associated with hemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Roberto da Justa Pires Neto
- Public Health Post-Graduate Program, Department of Community Health, School of Medicine, Federal University of Ceara, Fortaleza, Brazil.,Sao Jose Hospital of Infectious Diseases, Fortaleza, Brazil
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Silva AEP, Latorre MDRDDO, Chiaravalloti Neto F, Conceição GMDS. Temporal trends in leptospirosis incidence and association with climatic and environmental factors in the state of Santa Catarina, Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:849-860. [PMID: 35293463 DOI: 10.1590/1413-81232022273.45982020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Leptospirosis is a zoonosis with epidemic potential, especially after heavy rainfall causing river, urban and flash floods. Certain features of Santa Catarina's coastal region influence these processes. Using negative binomial regression, we investigated trends in the incidence of leptospirosis in the six municipalities with the highest epidemic peaks between 2000 and 2015 and the climatic and environmental variables associated with the occurrence of the disease. Incidence was highest in 2008 and 2011, and peaks occurred in the same month or month after disasters. Incidence showed a strong seasonal trend, being higher in summer months. There was a decrease trend in incidence across the six municipalities (3.21% per year). The climatic and environmental factors that showed the strongest associations were number of rainy days, maximum temperature, presence of flash floods, and river flooding. The impact of these variables varied across the municipalities. Significant interactions were found, indicating that the effect of river flooding on incidence is not the same across all municipalities and differences in incidence between municipalities depend on the occurrence of river flooding.
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Affiliation(s)
- Ana Elisa Pereira Silva
- Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715. 01246-904 São Paulo SP Brasil.
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Marteli AN, Genro LV, Diament D, Guasselli LA. Análise espacial da leptospirose no Brasil. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A leptospirose é um problema de saúde pública mundial. No Brasil, ela é uma doença de notificação compulsória e está relacionada a áreas com precárias condições sanitárias. Foi realizado um estudo ecológico retrospectivo para observar a distribuição espacial e temporal de casos confirmados da leptospirose em escala nacional no período entre 2007 e 2017. A espacialização da leptospirose utilizou técnicas de geoprocessamento por análise de padrões pontuais e por mapas de densidade Kernel. Os resultados revelaram que, no período, foram registrados 42.310 casos confirmados de leptospirose no País, com média anual de 3.846 casos e prevalência de 1,9 a cada 100 mil habitantes. As localidades com mais casos prevalentes foram as regiões Sul e Norte. O Sudeste apresentou taxa de prevalência inferior à taxa nacional em virtude da alta densidade demográfica. O método Kernel se mostrou útil na análise global da situação epidemiológica da leptospirose nas regiões do Brasil.
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Gomes PEADC, Brilhante SDO, Carvalho RB, Sousa DRD, Daher EDF. Pancreatitis as a severe complication of leptospirosis with fatal outcome: a case report. Rev Inst Med Trop Sao Paulo 2020; 61:e63. [PMID: 31859840 PMCID: PMC6907415 DOI: 10.1590/s1678-9946201961063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023] Open
Abstract
Leptospirosis is a globally distributed zoonosis with a broad clinical spectrum.
This disease mostly affects liver and kidney tissues. Other organs such as the
pancreas, can be affected by leptospirosis-induced vasculitis. In addition,
cardiac manifestations are common, and the presence of transient ECG
abnormalities can be found in 70% of the patients. We report a male patient who
presented with an atypical leptospirosis that progressed with severe acute
pancreatitis, acute kidney injury and atrial fibrillation. Early diagnosis and
adequate supportive therapy are crucial for the appropriated management of
symptoms.
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Affiliation(s)
- Pedro Eduardo Andrade de Carvalho Gomes
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza, Ceará, Brazil
| | - Sávio de Oliveira Brilhante
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza, Ceará, Brazil
| | - Rachel Bezerra Carvalho
- Hospital Geral de Fortaleza, Programa de Residência Médica em Nefrologia, Fortaleza, Ceará, Brazil
| | | | - Elizabeth De Francesco Daher
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Programa de Pós-Graduação em Ciências Médicas, Fortaleza, Ceará, Brazil
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Leptospirosis: different presentation and mortality in tropical and non-tropical areas. Intensive Care Med 2019; 46:825-826. [PMID: 31713641 DOI: 10.1007/s00134-019-05848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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Kallel H, Rozé B, Pons B, Mayence C, Mathien C, Resiere D, Melot B, Hommel D, Mehdaoui H, Carles M. Infections tropicales graves dans les départements français d’Amérique, Antilles françaises et Guyane. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies infectieuses. Ces territoires sont de plus l’objet de mouvements importants de populations, voyageurs ou migrants, ce qui joue un rôle significatif dans le développement d’épidémies et/ou de pathologies émergentes. Ces pathologies infectieuses dites « tropicales » peuvent nécessiter une prise en charge en réanimation. Nous rapportons ici les principales données récentes concernant ces pathologies (hors infection liée au VIH) ainsi que les stratégies diagnostiques et thérapeutiques, à l’usage des réanimateurs amenés à exercer en zone tropicale AG ou recevant en métropole des patients issus de cette région.
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Daher EDF, Soares DDS, Galdino GS, Macedo ÊS, Gomes PEADC, Pires Neto RDJ, Silva Junior GBD. Leptospirosis in the elderly: the role of age as a predictor of poor outcomes in hospitalized patients. Pathog Glob Health 2019; 113:117-123. [PMID: 31131724 DOI: 10.1080/20477724.2019.1621729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: The aim of this study was to investigate factors associated with poor outcomes among elderly hospitalized patients with leptospirosis. Methods: This is a retrospective cohort study with leptospirosis patients admitted to three tertiary hospitals in Fortaleza, Brazil, from January 1985 to July 2017. Patients were divided into two groups: elderly (age ≥60 years) and young (age <60 years). A comparison of demographical, clinical and laboratory data, treatment and outcomes was executed in order to investigate differences between groups. Results: A total of 507 hospitalized patients were included, with mean age 38 ± 15 years. Elderly group presented lower incidence of myalgia, vomiting, and dyspnea, as well as, higher medium systolic blood pressure. Elderly also manifested higher frequency of AKI (85.9 vs. 74.7%, p = 0.05), hemodialysis requirement (54.7 vs. 37.0%, p = 0.007) and death (32.8 vs. 12.2%, p < 0.001). In multivariate analysis, age ≥60 years was a predictor of hemodialysis requirement (p = 0.008, OR = 2.049, 95% CI = 1.207-3.477) and death (p < 0.001, OR = 3.520, 95% CI = 1.940-6.386). Conclusion: Leptospirosis in the elderly is associated with less hemodynamic impairment and higher frequency of AKI. Advanced age was also a predictor of poor outcomes, such as hemodialysis requirement and death, mostly due to kidney involvement.
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Affiliation(s)
- Elizabeth De Francesco Daher
- a Department of Internal Medicine, School of Medicine , Federal University of Ceará , Fortaleza , Ceará , Brazil
| | - Douglas de Sousa Soares
- a Department of Internal Medicine, School of Medicine , Federal University of Ceará , Fortaleza , Ceará , Brazil
| | - Gabriela Studart Galdino
- a Department of Internal Medicine, School of Medicine , Federal University of Ceará , Fortaleza , Ceará , Brazil
| | - Ênio Simas Macedo
- a Department of Internal Medicine, School of Medicine , Federal University of Ceará , Fortaleza , Ceará , Brazil
| | | | - Roberto da Justa Pires Neto
- b Department of Public Health, School of Medicine , Federal University of Ceará , Fortaleza , Ceará , Brazil
| | - Geraldo Bezerra da Silva Junior
- c Public Health and Medical Sciences Graduate Programs, School of Medicine, Health Sciences Center , University of Fortaleza , Fortaleza , Ceará , Brazil.,d Health Department , Federal Institute of Education, Science and Technology of Ceará , Fortaleza , Ceará , Brazil
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