Pasamba EM, Arakama MI, Danguilan RA and Mendoza MT
Introduction: Leptospirosis presenting with renal failure is often accompanied by pulmonary hemorrhage and carries a high mortality despite standard therapy. There is increasing evidence for an immunologic mechanism mediating both these complications hence methylprednisolone and cyclophosphamide were adapted in the treatment protocol to improve overall outcome.
Methods: This is a retrospective review of adults with leptospirosis and renal failure admitted at National Kidney and Transplant Institute from January 2014 to December 2016 treated with pulse immunosuppression followed up until hospital discharge. Primary outcome is overall survival while secondary outcomes include predictors of mortality, length of hospital stay, number of days on hemodialysis, use of blood products and occurrence of nosocomial infection.
Results: Among 194 patients included in the study, 49 (25%) patients died; 32 (16%) due to pulmonary hemorrhage, 13 (7%) due to multiple organ failure and 4 (2%) due to hospital acquired pneumonia. The 13% who developed pneumonia had a significantly longer hospital stay (p-value 0.0021). Significant predictors of mortality included a low platelet count (p-value<0.001), prolonged prothrombin time (p-value 0.026) and presence of parenchymal infiltrates on chest radiograph (p-value 0.001). Transfusion with platelet concentrate and fresh frozen plasma were significantly higher among patients who died (p-value of <0.001 and 0.042 respectively). Most patients were weaned off hemodialysis after an average of 2 days.
Conclusion & Recommendation: Although majority of patients survived this catastrophic disease, there was 25% mortality among patients in the study and majority died from pulmonary hemorrhage. Abnormal bleeding parameters and parenchymal infiltrates on chest radiograph significantly predicted death. Renal function recovered within 2 days of treatment regardless of mortality outcome. Pulmonary supportive therapy such as extracorporeal membrane oxygenation should be investigated to improve survival among patients with pulmonary hemorrhage.
