Severity markers in severe leptospirosis: a cohort study

Area of Science:

• Infectious Diseases
• Clinical Biochemistry
• Molecular Biology

Background:

• Leptospirosis is a zoonotic infection with variable clinical presentations.
• Identifying reliable severity markers is essential for timely clinical management and resource allocation.
• Current markers may not fully capture the dynamic progression of severe leptospirosis.

Purpose of the Study:

• To evaluate clinical, hematological, biochemical, and biological parameters as severity markers in hospitalized leptospirosis patients.
• To compare these parameters between patients with different severity levels.
• To assess the utility of these markers for predicting disease progression.

Main Methods:

• Prospective evaluation of 47 hospitalized adult leptospirosis patients.
• Assessment of clinical data, hematological and biochemical variables, and cytokine gene expression.
• Comparison of parameters at admission and the following day between severity groups (fatal or requiring mechanical ventilation/dialysis).

Main Results:

• Septic shock, high Simplified Acute Physiology Score (SAPS II), elevated lactate, total bilirubin, lipase, and AST/ALT ratio were associated with severity.
• Decreased IL-10/TNF-α cytokine ratio and increased gene expression of IL-1 receptor antagonist (IL-1ra), IL-1α, and PTX-3 were observed in severe cases.
• Significant patient improvement or deterioration occurred within 24 hours, necessitating reassessment.

Conclusions:

• Several biochemical and molecular parameters show potential as early severity markers for leptospirosis.
• Reassessment of patients the day after admission is critical due to rapid clinical changes.
• Further research is needed to validate these prognostic parameters for effective patient triage.