Federal University of Ceará, School of Medicine, School of Medicine, Department of Internal Medicine, Division of Nephrology, FortalezaCE, Brazil, Federal University of Ceará, School of Medicine, Department of Internal Medicine, Division of Nephrology, Fortaleza/CE, Brazil.
Federal University of Ceará, Department of Statistics, FortalezaCE, Brazil, Federal University of Ceará, Department of Statistics, Fortaleza/CE, Brazil.
Clinics (Sao Paulo). 2014 Feb;69(2):106-10. doi: 10.6061/clinics/2014(02)06.
This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area.
This retrospective study included 374 consecutive patients with leptospirosis who were admitted to tertiary hospitals in Fortaleza, Brazil. All patients had a diagnosis of severe leptospirosis (Weil's disease). Acute kidney injury was defined according to the RIFLE criteria. Thrombocytopenia was defined as a platelet count <100,000/mm3.
A total of 374 patients were included, with a mean age of 36.1 ± 15.5 years, and 83.4% were male. Thrombocytopenia was present at the time of hospital admission in 200 cases (53.5%), and it developed during the hospital stay in 150 cases (40.3%). The patients with thrombocytopenia had higher frequencies of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). The independent risk factors associated with thrombocytopenia during the hospital stay were lengthy disease (OR: 1.2, p=0.001) and acute kidney injury (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during the hospital stay (12.6% vs. 11.3%, p=0.748).
Thrombocytopenia is a frequent complication in leptospirosis, and this condition was present in more than half of patients at the time of hospital admission. Lengthy disease and acute kidney injury are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality.
本研究旨在调查在雷耶斯病流行地区的大型莱姆病患者队列中与血小板减少症相关的因素。
本回顾性研究纳入了 374 例连续莱姆病患者，这些患者均入住巴西福塔雷萨的三级医院。所有患者均确诊为严重莱姆病（魏尔氏病）。急性肾损伤的定义采用 RIFLE 标准。血小板减少症定义为血小板计数＜100,000/mm3。
共纳入 374 例患者，平均年龄为 36.1±15.5 岁，83.4%为男性。200 例（53.5%）患者在入院时即存在血小板减少症，150 例（40.3%）患者在住院期间发生血小板减少症。血小板减少症患者的脱水（53% vs. 35.3%，p=0.001）、鼻出血（5.7% vs. 0.8%，p=0.033）、呕血（13% vs. 4.6%，p=0.006）、肌痛（91.5% vs. 84.5%，p=0.038）、血尿（54.8% vs. 37.6%，p=0.011）、代谢性酸中毒（18% vs. 9.2%，p=0.016）和低白蛋白血症（17.8% vs. 7.5%，p=0.005）的发生率更高。住院期间发生血小板减少症的独立危险因素是病程较长（OR：1.2，p=0.001）和急性肾损伤（OR：6.6，p=0.004）。血小板减少症与入院时（12.5% vs. 12.6%，p=1.000）或住院期间（12.6% vs. 11.3%，p=0.748）的死亡率均无显著相关性。
血小板减少症是莱姆病的常见并发症，超过一半的患者在入院时即存在该并发症。病程较长和急性肾损伤是血小板减少症的危险因素。血小板减少症与死亡率之间无显著相关性。
