Abstract:
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.
