Age as Prognostic Factor in Leptospirosis

Purpose: To assess the age as prognostic criterion for severity and mortality in leptospirosis. Methods: We performed retrospective analysis of 100 consecutive leptospirosis cases treated in Clinic of Infectious Diseases at University Hospital – Pleven (1976-2015) (n=100, 90 male, age 37±18 years, urban residents 61%, lethal outcome in 13%), grouped in three age groups – group A (age≤17 years; n1=13), group B (age 18-44 years; n2=55) and group C (age≥45 years; n3=32). Comparative analysis of clinical manifestations, laboratory parameters and outcome was performed. Severity of cases was complexly assessed as mild, moderate and severe and φ-coefficient by modified Pearson’s test (interpreted by three-grade score as follows: weak correlation at φ<0.3, moderate 0.31<φ<0.7 and strong – φ≥0.7) was used about correlation with age. Odds ratios (ORs) were calculated. Results: Mild, moderate and severe cases in group A were 7, 6 and zero, respectively; in group B – 18, 24 and 13 and in group C – 2, 9 and 21. Moderate correlation of severity with age was established in group B (φ=0.53) and strong in group C (φ=0.84). One case in group B and twelve in group C were with lethal outcome (OR 32.4; p<0.0005). The major factors leading to death were lung and brain edema (OR 25.00 and 17.29, respectively) due to severe acute renal failure. Conclusion: Age over 45 years is associated with severe course of leptospirosis and higher risk for death and requires early intensive treatment.