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Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions
Benjamin Delmas1, Julien Jabot1, Paul Chanareille1
1Intensive Care Unit, Félix Guyon Hospital, University Teaching Hospital of La Réunion, CS11021, Saint Denis, Reunion Island, France.
Insights
Severe leptospirosis has a lower mortality rate than other bacterial infections when modern organ support is available. Prompt intensive care unit (ICU) interventions significantly reduce deaths, even in critically ill patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Nephrology
Background:
- Leptospirosis is a severe bacterial infection causing reversible multiple organ failure with high mortality.
- Effective treatment strategies for severe leptospirosis, particularly in intensive care settings, are crucial.
Purpose of the Study:
- To determine the mortality rate of leptospirosis in an intensive care unit (ICU) with comprehensive organ support.
- To compare the mortality of leptospirosis with that of bacterial sepsis.
Main Methods:
- A retrospective, descriptive, single-center cohort study was conducted.
- 134 consecutive patients with leptospirosis admitted to the ICU of Reunion Island between 2004 and 2015 were analyzed.
Main Results:
- The overall mortality rate for leptospirosis in the ICU was 6.0%.
- Patients requiring mechanical ventilation (31%) and renal replacement therapy (56%) had significant morbidity.
- The standardized mortality ratio for leptospirosis patients, adjusted for severity scores, was significantly lower (0.40) compared to bacterial sepsis.
Conclusions:
- Severe leptospirosis has a lower mortality rate than other bacterial infections when modern resuscitation techniques and organ support are available.
- Prompt and comprehensive organ support in the ICU is associated with very low mortality rates, even in patients with high severity scores.
Objectives:
Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis.
Design:
Retrospective, descriptive, and single-center cohort study.
Settings:
The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital.
Patients:
Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015.
Interventions:
None.
Measurements And Main Results:
We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30-52 yr), with a Simplified Acute Physiology Score II of 38 (27-50) and a Sequential Organ Failure Assessment score of 10 (8-12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0-1) day after admission with a median urea of 25 mmol/L (17-32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6-11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 - 0.79).
Conclusions:
The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.
