Annals of Tropical Medicine and Public Health
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Year : 2012  |  Volume : 5  |  Issue : 3  |  Page : 240-244

Predictors of the development of myocarditis and acute renal failure in patients with leptospirosis

1 Consultant Physician, Teaching Hospital, Kandy, Sri Lanka
2 Department of Community Medicine, Faculty of Medicine and Allied Sciences, Saliyapura, Anuradhapura, Sri Lanka
3 Registrar in Medicine, Teaching Hospital, Kandy, Sri Lanka
4 Teaching Hospital, Kandy, Sri Lanka

Correspondence Address:
Dinesh Dassanayake
Registrar in Medicine, Teaching Hospital, Kandy
Sri Lanka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.98627

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Background: Leptospirosis has a varied clinical presentation with complications such as myocarditis and acute renal failure. There are various predictors of severity and mortality, including clinical and laboratory parameters. Early detection and treatment can reduce complications. Therefore, recognizing the early predictors of the complications of leptospirosis is important in patient management. Aims: This study was aimed at determining the clinical and laboratory predictors of myocarditis and acute renal failure. Setting and Design: This is a prospective descriptive study carried out in medical wards of our hospital from July 1, 2007, to July 31, 2008. Materials and Methods: Patients with clinical features compatible with leptospirosis case definition were confirmed using the Microscopic Agglutination Test (MAT). Clinical features and laboratory investigations done on admission were recorded. The patients were observed for the development of acute renal failure and myocarditis. Statistical Analysis: Chi-square statistics, Fisher's exact test, and Student's t test were used to compare patients with and without complications. A logistic regression model and backward stepwise elimination of variables was carried out to select final variables. Results: Sixty-two confirmed leptospirosis patients were included in the study. Six patients (9.6%) developed acute renal failure and five (8%) developed myocarditis, while three (4.8%) had acute renal failure and myocarditis together. Conjunctival suffusion - 40 (65%), muscle tenderness - 28 (45%), oliguria - 20 (32%), jaundice - 12 (19%), hepatomegaly - 10 (16%), arrhythmias (irregular radial pulse) - 8 (13%), chest pain - 6 (10%), bleeding - 5 (8%), and shortness of breath (SOB) - 4 (6%) were the common clinical features present in the patients. Of these, only oliguria {Odds Ratio (OR) = 4.14, 95% Confidence Interval (CI) = 1.003 - 17.261}, jaundice (OR = 5.13, 95% CI = 1.149 - 28.003), and arrhythmias (OR = 5.774, 95% CI = 1.001 - 34.692), were predictors of myocarditis and acute renal failure and none of the laboratory investigations could predict the two complications. Conclusion: This study shows that out of clinical and laboratory variables, only oliguria, jaundice, and arrhythmia are strong predictors of development of acute renal failure and myocarditis.

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