斯里兰卡一组血清学确诊钩端螺旋体病患者严重程度的临床和实验室关联：一项前瞻性研究

Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study.

作者信息

Rajapakse Senaka, Weeratunga Praveen, Niloofa M J Roshan, Fernando Narmada, Rodrigo Chathuraka, Maduranga Sachith, de Silva Nipun Lakshitha, de Silva H Janaka, Karunanayake Lilani, Handunnetti Shiroma

机构信息

Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka.

Tropical Medicine Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka

出版信息

Trans R Soc Trop Med Hyg. 2015 Nov;109(11):710-6. doi: 10.1093/trstmh/trv079.

DOI:10.1093/trstmh/trv079

PMID:26464233

Abstract

BACKGROUND

Leptospirosis results in significant morbidity and mortality. This study elucidates markers of severity in a cohort of Sri Lankan patients.

METHODS

Patients presenting to three healthcare institutions in the Western province of Sri Lanka with leptospirosis serological confirmed by the microscopic agglutination test (MAT) were included. Prospective data regarding demographic, clinical and laboratory parameters was extracted. Univariate associations and subsequent multivariate logistic regression models were constructed.

RESULTS

The study included 232 patients, with 68.5% (159) demonstrating severe disease. Significant associations of severe disease at a significance level of p<0.05 were fever >38.8°C on presentation, age >40 years, muscle tenderness, tachycardia on admission, highest white cell count >12 350/mm(3) and <7900/mm(3), highest neutrophil percentage >84%, haemoglobin >11.2 g/dL and <10.2 g/dL, packed cell volume (PCV) >33.8% and <29.8%, lowest platelet count <63 500/mm(3), highest alanine transaminase (ALT) >70 IU/L and hyponatremia with sodium <131 mEq/L. On multivariate analysis, PCV <29.8% (p=0.011; OR 3.750; CI: 1.394-10.423), ALT >70 IU/L (p=0.044; OR 2.639; CI: 1.028-6.774) and hyponatremia <131 mEq/L (p=0.019; OR 6.413; CI: 1.353-30.388) were independent associations of severe disease.

CONCLUSIONS

Severity associations were demonstrated with both clinical and laboratory parameters. There is a need for novel biomarkers for prediction of severity in leptospirosis.

摘要

背景

钩端螺旋体病会导致显著的发病率和死亡率。本研究阐明了一组斯里兰卡患者的严重程度标志物。

方法

纳入在斯里兰卡西部省三家医疗机构就诊且经显微镜凝集试验（MAT）血清学确诊为钩端螺旋体病的患者。提取有关人口统计学、临床和实验室参数的前瞻性数据。构建单变量关联和随后的多变量逻辑回归模型。

结果

该研究纳入了232名患者，其中68.5%（159名）表现为重症疾病。在p<0.05的显著性水平下，重症疾病的显著关联因素包括就诊时发热>38.8°C、年龄>40岁、肌肉压痛、入院时心动过速、最高白细胞计数>12350/mm³和<7900/mm³、最高中性粒细胞百分比>84%、血红蛋白>11.2g/dL和<10.2g/dL、红细胞压积（PCV）>33.8%和<29.8%、最低血小板计数<63500/mm³、最高丙氨酸转氨酶（ALT）>70IU/L以及低钠血症且血钠<131mEq/L。多变量分析显示，PCV<29.8%（p=0.011；OR 3.750；CI：1.394 - 10.423）、ALT>70IU/L（p=0.044；OR 2.639；CI：1.028 - 6.774）和低钠血症<131mEq/L（p=0.019；OR 6.413；CI：1.353 - 30.388）是重症疾病的独立关联因素。