Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu

Background: Leptospirosis has a wide range of clinical presentation from mild to severe disease with organ dysfunctions and death. There are risk and prognostic factors for severity and mortality including demographic, epidemiological, clinical presentations and laboratory results. Early recognitio...

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Main Author:	Yen, Yew Chee
Format:	Thesis
Language:	English
Published:	2017
Subjects:	RA643-645 Disease (Communicable and noninfectious) and public health
Online Access:	http://eprints.usm.my/45696/1/Dr.%20Yew%20Chee%20Yen-24%20pages.pdf
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spelling	my-usm-ep.456962019-10-21T04:26:32Z Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu 2017 Yen, Yew Chee RA643-645 Disease (Communicable and noninfectious) and public health Background: Leptospirosis has a wide range of clinical presentation from mild to severe disease with organ dysfunctions and death. There are risk and prognostic factors for severity and mortality including demographic, epidemiological, clinical presentations and laboratory results. Early recognition of risk factors enables early ICU care and organ supports. Purpose: The study was conducted to identify the risk and prognostic factors for severe leptospirosis and its mortality. Methods: This was a retrospective case-control study carried out in the general ICU in Hospital Raja Perempuan Zainab II from 1st January 2013 to 31st December 2016. Patients who presented with severe organ involvement which required dialysis, tracheal intubation and mechanical ventilation, vasopressors or inotropes, transfusion or death were grouped as cases. Controls were defined as patient with mild organ involvement without requirement or with minimal organ supports. Chi-Square test, Fisher‘s exact test, Student t-test or Mann Whitney test was used. A logistic regression model was used to select final prognostic factors. Results: Ninety six leptospirosis patients were included in the study. Among 96 patients enrolled in the study, 66 patients were in the severe group, 30 patients were in the control group. Seven risk factors independently associated with severe leptospirosis: Aspartate Transferase (AST) (OR: 4.2 [1.608, 10.970], P=0.002); Alanine Transferase (ALT) (OR:2.857 [1.153, 7.082], P=0.021); Urea (OR:2.895 [1.081,7.753], P=0.031); Prothrombin time (PT) (OR:4.797 [1.629,14.126], P=0.003); International Normalised Ratio (INR) (OR: 3.714[1.157, 11.920], P=0.021); Ratio (OR: 8.399); Creatine kinase MB (CKMB) (OR:7.0 [1.961,24.985], P=0.001). Six independent risk factors were associated with mortality: Simplified Acute Physiology Score II (SAPS II) score (OR: 1.045 [1.007-1.083], P=0.019); PT (1.069 [0.00--], P=0.038); INR (OR: 4.48 [1.524-13.17], P=0.005), Activated partial thromboplastin time (APTT) (OR:2.933 [0.993-8.66], P=0.048), ratio (OR:21.87[2.52-189.86], P=0.001), Electrocardiography (ECG) (OR1.13 [0.00--], P=0.048) Conclusion: Leptospirosis patients with elevated liver enzymes, elevated urea, coagulopathy and elevated CKMB were risky to develop severe leptospirosis. SAPS II, coagulopathy and ECG changes were high risk for mortality. 2017 Thesis http://eprints.usm.my/45696/ http://eprints.usm.my/45696/1/Dr.%20Yew%20Chee%20Yen-24%20pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RA643-645 Disease (Communicable and noninfectious) and public health
spellingShingle	RA643-645 Disease (Communicable and noninfectious) and public health Yen, Yew Chee Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu
description	Background: Leptospirosis has a wide range of clinical presentation from mild to severe disease with organ dysfunctions and death. There are risk and prognostic factors for severity and mortality including demographic, epidemiological, clinical presentations and laboratory results. Early recognition of risk factors enables early ICU care and organ supports. Purpose: The study was conducted to identify the risk and prognostic factors for severe leptospirosis and its mortality. Methods: This was a retrospective case-control study carried out in the general ICU in Hospital Raja Perempuan Zainab II from 1st January 2013 to 31st December 2016. Patients who presented with severe organ involvement which required dialysis, tracheal intubation and mechanical ventilation, vasopressors or inotropes, transfusion or death were grouped as cases. Controls were defined as patient with mild organ involvement without requirement or with minimal organ supports. Chi-Square test, Fisher‘s exact test, Student t-test or Mann Whitney test was used. A logistic regression model was used to select final prognostic factors. Results: Ninety six leptospirosis patients were included in the study. Among 96 patients enrolled in the study, 66 patients were in the severe group, 30 patients were in the control group. Seven risk factors independently associated with severe leptospirosis: Aspartate Transferase (AST) (OR: 4.2 [1.608, 10.970], P=0.002); Alanine Transferase (ALT) (OR:2.857 [1.153, 7.082], P=0.021); Urea (OR:2.895 [1.081,7.753], P=0.031); Prothrombin time (PT) (OR:4.797 [1.629,14.126], P=0.003); International Normalised Ratio (INR) (OR: 3.714[1.157, 11.920], P=0.021); Ratio (OR: 8.399); Creatine kinase MB (CKMB) (OR:7.0 [1.961,24.985], P=0.001). Six independent risk factors were associated with mortality: Simplified Acute Physiology Score II (SAPS II) score (OR: 1.045 [1.007-1.083], P=0.019); PT (1.069 [0.00--], P=0.038); INR (OR: 4.48 [1.524-13.17], P=0.005), Activated partial thromboplastin time (APTT) (OR:2.933 [0.993-8.66], P=0.048), ratio (OR:21.87[2.52-189.86], P=0.001), Electrocardiography (ECG) (OR1.13 [0.00--], P=0.048) Conclusion: Leptospirosis patients with elevated liver enzymes, elevated urea, coagulopathy and elevated CKMB were risky to develop severe leptospirosis. SAPS II, coagulopathy and ECG changes were high risk for mortality.
format	Thesis
qualification_level	Master's degree
author	Yen, Yew Chee
author_facet	Yen, Yew Chee
author_sort	Yen, Yew Chee
title	Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu
title_short	Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu
title_full	Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu
title_fullStr	Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu
title_full_unstemmed	Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu
title_sort	risk and prognostic factors for severe leptospirosis in adult population in intensive care unit hospital perempuan zainab ii, kota bharu
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2017
url	http://eprints.usm.my/45696/1/Dr.%20Yew%20Chee%20Yen-24%20pages.pdf
_version_	1747821548241158144

Risk and prognostic factors for severe leptospirosis in adult population in intensive care unit Hospital Perempuan Zainab II, Kota Bharu

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