Pulmonary haemorrhage as a frequent cause of death among patients with severe complicated Leptospirosis in Southern Sri Lanka.

Autor: Chathuranga Lakmal Fonseka, Niroshana Jathun Dahanayake, Denagama J D Mihiran, Kalani Mithunika Wijesinghe, Lakshani Nawanjana Liyanage, Hesaru S Wickramasuriya, Gaya Bandara Wijayaratne, Kelum Sanjaya, Champica K Bodinayake
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: PLoS Neglected Tropical Diseases, Vol 17, Iss 10, p e0011352 (2023)
Druh dokumentu: article
ISSN: 1935-2727
1935-2735
79496180
DOI: 10.1371/journal.pntd.0011352&type=printable
Popis: BackgroundLeptospirosis is a tropical disease associated with life threatening complications. Identifying clinical and investigation-based parameters that predict mortality and morbidity is vital to provide optimal supportive care.MethodsWe conducted an observational study in an endemic setting, in the southern Sri Lanka. Consecutive patients having complicated leptospirosis were recruited over 18 months. Clinical, investigational and treatment data were collected and the predictors of mortality were analysed.ResultsOut of 88 patients having complicated leptospirosis, 89% were male. Mean age was 47yrs (±16.0). Among the total major complications 94.3% had acute kidney injury, 38.6% pulmonary haemorrhages, 12.5% fulminant hepatic failure, 60.2% hemodynamic instability and 33% myocarditis. An acute significant reduction of haemoglobin (Hb) was observed in 79.4% of patients with pulmonary haemorrhage. The mean of the highest haemoglobin reduction in patients with pulmonary haemorrhage was 3.1g/dL. The presence of pulmonary haemorrhage (PH) and hemodynamic instability within first 48 hours of admission significantly predicted mortality (pConclusionsWithin first 48 hours of admission, major complications such as pulmonary haemorrhage and haemodynamic instability and other parameters such as atrial fibrillation, acute haemoglobin reduction, elevated SGOT level could be used as early parameters predictive of mortality in severe leptospirosis. PH and FHF during the first week of admission in leptospirosis are associated with high morbidity and mortality requiring prolonged ICU care and hospitalisation. Above parameters could be used as parameters indicating severity for triaging and intensifying treatment. Using ECMO is a plausible treatment option in patients with severe pulmonary haemorrhage.
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