Predictors of Lethality in Severe Leptospirosis in Urban Brazil
Predictors of Lethality in Severe Leptospirosis in Urban Brazil
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DOI：
10.4269/ajtmh.2008.79.911
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发表时间：
2008-12-01
影响因子：
3.3
通讯作者：
Vinetz, Joseph M.
中科院分区：
文献类型：
--
作者：
Spichler, Anne S.;Vilaca, Pedro J.;Vinetz, Joseph M.
为了确定与严重钩端螺旋体病致死性结局相关的预后因素，利用基于人群的监测数据进行了一项回顾性病例对照研究。钩端螺旋体病死亡率的集中死亡证明报告与患者住院的详细信息相结合，这些信息来自代表圣保罗市所有部门的医院。在确诊的钩端螺旋体病病例中，分析了89例死亡病例和281例存活病例。死亡的预测因素包括年龄> 40岁、出现少尿、血小板计数<70，000/mu L、肌酐> 3 mg/dL。和肺部受累。后者是最强的危险因素，所有估计比值比为6.0（95%置信区间：3.0 - 12.0）。血清学结果与最高滴度对钩端螺旋体血清型Copenhageni没有显示出显着差异的幸存者和非幸存者。肺受累是圣保罗钩端螺旋体病死亡的一个重要预测因子，在该并发症常见的钩端螺旋体病流行地区具有相关性。
To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients' hospitalizations, which were obtained from hospitals representing all sectors of Sao Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age > 40 years, development of oliguria, platelet count < 70,000/mu L, creatinine > 3 mg/dL. and pulmonary involvement. The latter was the strongest risk Factor with all estimated odds ratio of 6.0 (95% confidence interval: 3.0-12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in Sao Paulo, of relevance in leptospirosis-endemic regions where this complication is common.