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Severity markers in severe leptospirosis: a cohort study

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Abstract

We aimed to evaluate parameters for their value as severity markers in hospitalized leptospirosis patients. We recruited 47 informed adult consenting patients and assessed a number of clinical, hematological, biochemical, and biological variables. Patients were sorted according to severity based on fatality or the requirement of mechanical ventilation or dialysis; the parameters studied were compared between groups on inclusion and the next day. Beside septic shock presentation or a high severity score (Simplified Acute Physiology Score; SAPS II), increased lactate, total bilirubin, lipase, and AST/ALT ratio or a decreased cytokines IL-10/TNF-α ratio were all significantly associated with severity. The gene expression of the IL-1 receptor antagonist IL-1ra, IL-1α, and the long pentraxin PTX-3 were also transcribed at higher levels in most severe cases. Patients could rapidly improve or deteriorate, highlighting the need for a new assessment the next day. Our results add to the limited body of knowledge about severity markers in leptospirosis. They also suggest that patients should be reassessed the next day before being possibly discharged from the hospital. Further studies are needed in order to confirm relevant and reliable prognostic parameters in leptospirosis that would be helpful for the purpose of triage.

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Acknowledgments

Thanks are due to the medical staff of the Centre Hospitalier Territorial hospital units who collected samples for the study while taking care of the patients, to the staff of Institut Pasteur Medical Biology Laboratory for the analyses, and to Fidèl Jiomekong Azanzi for building a useful data capture application. The investigators are also grateful to Pr Suzanne Chanteau, former director of Institut Pasteur in New Caledonia, for her continued support of this research.

Conflict of interest

The authors declare that they have no competing interests.

Authors’ contributions

Study conception: CG, FV-P. Study design: CG, FV-P, PB, FL, MM, DB. Patient recruitment and care: MM, FL, DB. Biological analyses: M-ES-G, CM, LB-O, YB, A-CG. Data management: PB, M-ES-G, CM, LB-O. Analyzed the data: PB, CG. Wrote the paper: CG, with contributions from all authors, who read and approved the final version.

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Correspondence to C. Goarant.

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Supplementary Table 1

Primers and product sizes and melting temperatures for gene expression analysis (DOCX 15 kb)

Supplementary Table 2

Selected parameters upon inclusion for patients who deteriorated during the first day of hospital stay (PDF 196 kb)

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Mikulski, M., Boisier, P., Lacassin, F. et al. Severity markers in severe leptospirosis: a cohort study. Eur J Clin Microbiol Infect Dis 34, 687–695 (2015). https://doi.org/10.1007/s10096-014-2275-8

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  • DOI: https://doi.org/10.1007/s10096-014-2275-8

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