A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure
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). Logis...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Tropical Medicine and Infectious Disease |
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| Online Access: | https://www.mdpi.com/2414-6366/7/1/7 |
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| author | Rizza Antoinette Yap So Romina A. Danguilan Eric Chua Mel-Hatra I. Arakama Joann Kathleen B. Ginete-Garcia Joselito R. Chavez |
| author_facet | Rizza Antoinette Yap So Romina A. Danguilan Eric Chua Mel-Hatra I. Arakama Joann Kathleen B. Ginete-Garcia Joselito R. Chavez |
| author_sort | Rizza Antoinette Yap So |
| collection | DOAJ |
| description | 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, <i>p</i> < 0.0001), hemoptysis (OR = 20.73, <i>p</i> < 0.0001), diabetes (OR = 10.21, <i>p</i> < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, <i>p</i> < 0.0001), thrombocytopenia (OR = 3.54, <i>p</i> < 0.0029), and oliguria/anuria (OR = 3.15, <i>p</i> < 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. |
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| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2414-6366 |
| language | English |
| last_indexed | 2024-03-10T00:25:07Z |
| publishDate | 2022-01-01 |
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| series | Tropical Medicine and Infectious Disease |
| spelling | doaj.art-cacaa7cfe9ba43558ef529a6078c5e742023-11-23T15:36:37ZengMDPI AGTropical Medicine and Infectious Disease2414-63662022-01-0171710.3390/tropicalmed7010007A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney FailureRizza Antoinette Yap So0Romina A. Danguilan1Eric Chua2Mel-Hatra I. Arakama3Joann Kathleen B. Ginete-Garcia4Joselito R. Chavez5Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City 1101, PhilippinesDepartment of Adult Nephrology, National Kidney and Transplant Institute, Quezon City 1101, PhilippinesDepartment of Adult Nephrology, National Kidney and Transplant Institute, Quezon City 1101, PhilippinesDepartment of Adult Nephrology, National Kidney and Transplant Institute, Quezon City 1101, PhilippinesDepartment of Internal Medicine, National Kidney and Transplant Institute, Quezon City 1101, PhilippinesDepartment of Internal Medicine, National Kidney and Transplant Institute, Quezon City 1101, PhilippinesRapid 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, <i>p</i> < 0.0001), hemoptysis (OR = 20.73, <i>p</i> < 0.0001), diabetes (OR = 10.21, <i>p</i> < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, <i>p</i> < 0.0001), thrombocytopenia (OR = 3.54, <i>p</i> < 0.0029), and oliguria/anuria (OR = 3.15, <i>p</i> < 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.https://www.mdpi.com/2414-6366/7/1/7mortalitypredictorspulmonary complicationspulmonary hemorrhagesevere leptospirosis |
| spellingShingle | Rizza Antoinette Yap So Romina A. Danguilan Eric Chua Mel-Hatra I. Arakama Joann Kathleen B. Ginete-Garcia Joselito R. Chavez A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure Tropical Medicine and Infectious Disease mortality predictors pulmonary complications pulmonary hemorrhage severe leptospirosis |
| title | A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure |
| title_full | A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure |
| title_fullStr | A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure |
| title_full_unstemmed | A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure |
| title_short | A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure |
| title_sort | scoring tool to predict pulmonary complications in severe leptospirosis with kidney failure |
| topic | mortality predictors pulmonary complications pulmonary hemorrhage severe leptospirosis |
| url | https://www.mdpi.com/2414-6366/7/1/7 |
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