Pulmonary manifestations of leptospirosis
| Autor: | F. Paganin, C. Dalban, J.-B. Noel, A. Gouix, C. Arvin-Berod, Gianandrea Borgherini, P. Poubeau, F. Tixier, Arnaud Bourdin, L. Cotte |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Lung Diseases Male Pulmonary and Respiratory Medicine medicine.medical_specialty Disease Opportunistic Infections Severity of Illness Index Young Adult Risk Factors Cause of Death Zoonoses Internal medicine Intensive care Pneumonia Bacterial Animals Humans Medicine Leptospirosis Major complication Intensive care medicine Retrospective Studies Cross Infection Respiratory Distress Syndrome Univariate analysis Extensive Disease business.industry Mortality rate Retrospective cohort study Acute Kidney Injury Middle Aged Prognosis medicine.disease Respiration Artificial Survival Analysis Rats Survival Rate Hospitalization Intensive Care Units Multivariate Analysis Disease Progression Female business Reunion |
| Zdroj: | Revue des Maladies Respiratoires. 28:e131-e139 |
| ISSN: | 0761-8425 |
| Popis: | Pulmonary manifestations in leptospirosis are considered a major complication and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF).A retrospective study of patients with confirmed leptospirosis.One hundred and sixty-nine patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. One hundred and thirty-four patients (36.7±14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of ARF. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR=10.14, p0.0001), pulmonary crepitations (OR=4.8, p0.0004), abnormal chest X-ray (OR=9.88, p0.007) with alveolar shadowing (OR=8.12, p0.0001), oliguria/anuria (OR=5.48, p0.0001), hepatomegaly (OR=7.11, p0.0001), shock (OR=8.38, p0.0001), ICU admission (OR=60.08, p0.0001), dialysis (OR=4.87, p0.001), mechanical ventilation (OR=216, p0.0001) and development of nosocomial infection (OR=21.5, p0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR=11.87, p0.0001). Multivariate analysis found two independent factors related to severe pulmonary involvement: dyspnoea (OR=10.18, p0.0001) and oliguria/anuria (OR=4.87, p0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: mechanical ventilation requirement (OR=27.85, p0.0001) and AST greater than 150 IU/L (OR=4.57, p0.02). Haemoptysis was associated with survival (OR=0.2, p0.02).Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiple factors is associated with severe forms of the disease and a high mortality rate. |
| Databáze: | OpenAIRE |
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