Journal of Emergencies, Trauma, and Shock
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ORIGINAL ARTICLE
Year : 2010  |  Volume : 3  |  Issue : 3  |  Page : 213-219

Developing a clinically relevant classification to predict mortality in severe leptospirosis


1 Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
2 University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
3 University College London, London, United Kingdom

Correspondence Address:
Senaka Rajapakse
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.66519

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Background : Severe leptospirosis requires critical care and has a high mortality. We reviewed the literature to identify factors predicting mortality, and such predictors were classified according to the predisposition, infection, response, organ dysfunction (PIRO) concept, which is a risk stratification model used in severe sepsis. Material and Methods : PUBMED was searched for all articles (English), with the key word "leptospirosis" in any field, within the last 20 years. Data were collected from 45 relevant papers and grouped into each component of the PIRO model. Results : The following correlated with increased mortality: predisposition - increasing age and chronic alcoholism; infection - leptospiraemic burden; response - hemodynamic disturbances, leukocytosis; organ dysfunction - multiple organ dysfunction syndrome, pulmonary involvement and acute renal failure. Conclusions : Further research is needed to identify the role of infecting serovars, clinical signs, inflammatory markers, cytokines and evidence of hepatic dysfunction as prognostic indicators. It is hoped that this paper will be an initiative to create a staging system for severity of leptospirosis based on the PIRO model with an added component for treatment-related predictors.


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