Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/12318
Title: Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model.
Authors: Marotto, Paulo Cesar Fumagalli
Ko, Albert Icksang
Nascimento, Cristiane Murta Ramalho
Seguro, Antonio Carlos
Prado, Rogerio R
Barbosa, Marcia C
Cleto, Sergio Aparecido
Eluf Neto, José
Affilliation: Intensive Care Unit. Emílio Ribas Institute of Infectology. Sao Paulo, SP, Brasil
Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Weill Cornell Medical College. Division of Infectious Diseases. Department of Medicine. New York, NY, USA
Hospital del Mar-IMAS. Evaluation and Clinical Epidemiology Unit. Barcelona, Spain / CIBER in Epidemiology and Public Health (CIBERESP). Barcelona, Spain
University of Sao Paulo. Laboratory of Basic Science (LIM 12). Department of Nephrology. Sao Paulo, SP, Brasil
University of Sao Paulo. Department of Preventive Medicine. Sao Paulo, SP, Brasil
Intensive Care Unit. Emílio Ribas Institute of Infectology. Sao Paulo, SP, Brasil
Intensive Care Unit. Emílio Ribas Institute of Infectology. Sao Paulo, SP, Brasil
University of Sao Paulo. Department of Preventive Medicine. Sao Paulo, SP, Brasil
Abstract: OBJECTIVE: To identify prediction factors for the development of leptospirosis-associated pulmonary hemorrhage syndrome (LPHS). METHODS: We conducted a prospective cohort study. The study comprised of 203 patients, aged > or =14 years, admitted with complications of the severe form of leptospirosis at the Emílio Ribas Institute of Infectology (Sao Paulo, Brazil) between 1998 and 2004. Laboratory and demographic data were obtained and the severity of illness score and involvement of the lungs and others organs were determined. Logistic regression was performed to identify independent predictors of LPHS. A prospective validation cohort of 97 subjects with severe form of leptospirosis admitted at the same hospital between 2004 and 2006 was used to independently evaluate the predictive value of the model. RESULTS: The overall mortality rate was 7.9%. Multivariate logistic regression revealed that five factors were independently associated with the development of LPHS: serum potassium (mmol/L) (OR = 2.6; 95% CI = 1.1-5.9); serum creatinine (micromol/L) (OR = 1.2; 95% CI = 1.1-1.4); respiratory rate (breaths/min) (OR = 1.1; 95% CI = 1.1-1.2); presenting shock (OR = 69.9; 95% CI = 20.1-236.4), and Glasgow Coma Scale Score (GCS) < 15 (OR = 7.7; 95% CI = 1.3-23.0). We used these findings to calculate the risk of LPHS by the use of a spreadsheet. In the validation cohort, the equation classified correctly 92% of patients (Kappa statistic = 0.80). CONCLUSIONS: We developed and validated a multivariate model for predicting LPHS. This tool should prove useful in identifying LPHS patients, allowing earlier management and thereby reducing mortality.
DeCS: Hemorragia/etiologia
Leptospirose/complicações
Leptospirose/diagnóstico
Pneumonia Bacteriana/etiologia
Adolescente
Adulto
Brasil
Estudos de Coortes
Feminino
Hemorragia/mortalidade
Humanos
Leptospirose/mortalidade
Masculino
Pneumonia Bacteriana/mortalidade
Prognóstico
Estudos Prospectivos
Fatores de Risco
Índice de Gravidade de Doença
Adulto Jovem
Issue Date: 2010
Publisher: WB Saunders
Citation: MAROTTO, P. C. F. et al. Early identification of leptospirosis-associated pulmonary hemorrhage syndrome by use of a validated prediction model. Journal of Infection, v. 60, n. 3, p. 218-223, 2010.
DOI: 10.1016/j.jinf.2009.12.005
ISSN: 1532-2742
Copyright: open access
Appears in Collections:BA - IGM - Artigos de Periódicos

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