Manifestações clinicas, classificação da lesão renal aguda e fatores de risco para óbito em pacientes com a forma grave de leptospirose

• Autor(a) principal: Silva Júnior, Geraldo Bezerra da
• Data de Publicação: 2010
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
• Texto Completo: http://www.repositorio.ufc.br/handle/riufc/10340
• topic: Leptospirose; Doença de Weil; Lesão Renal Aguda

Introduction. Leptospirosis is en endemic disease in Northeast of Brazil, which is characterized by potential fatal complications such as acute kidney injury (AKI). The aim of this study was to evaluate the clinical manifestations, the AKI classification and the risk factors for death in patients with the severe form of leptospirosis. Methods. A retrospective study was conducted in patients with severe form of leptospirosis admitted to tertiary hospitals in Fortaleza city, Northeast of Brazil. The clinical manifestations, laboratory tests at admission and during hospital stay, as well as treatment, were evaluated. AKI was defined according to the RIFLE and AKIN classifications, and the patients in each category were compared. Patients who used and who did not use penicillin, as well as survivors and non-survivors, were compared. Univariate and multivariate analysis were performed to investigate the risk factors for death. Statistical analysis was done with SPSS program version 10.0. Results. A total of 287 patients were included, with a mean age of 36.8±15.6 years, and 80.8% were male. The main signs and symptoms at admission were fever (96.2%), myalgia (90.6%), jaundice (85.7%), headache (74.2%), vomiting (70.7%), dehydration (54%) and chills (53.7%). AKI was observed in 237 patients (82%) according to the RIFLE criteria and 242 (84%) according to AKIN. General mortality was 13%. Mortality was similar in patients who used and who did not use penicillin (11.6% vs. 13.7%, p=0.60). An increase in mortality was observed according to the worst classifications of RIFLE and AKIN: RIFLE-R (2%), RIFLE-I (8%) e RIFLE-F (23%), AKIN 1 (2%), AKIN 2 (8%) e AKIN 3 (23%), p<0.0001. Patients with oliguria had a higher mortality (20%), when compared to those without oliguria (5%), p=0.02. Independent risk factors for death were: RIFLE-F (OR=10.5, 95% CI=1.3-80.8, p<0.001), AKIN 3 (OR=7.5, 95% CI=2.2-25.2 p<0.001) and need of dialysis (OR=3.5, 95% CI=1.1-11.01, p=0.01). Conclusions. AKI is a frequent complication in leptospirosis, with significant mortality. There was association between RIFLE and AKIN classifications with mortality. Independent risk factors for death were RIFLE-F, AKIN 3 and need of dialysis.