Predictors of in-hospital mortality in severe leptospirosis: a retrospective cohort study (São Paulo, 2017–2025)
- 1Departamento de Infectologia e Doenças Tropicais da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
- 2Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
- 3Núcleo de Vigilância Epidemiológica do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, São Paulo, Brazil
Abstract
Purpose: Although advances in intensive care have improved survival of patients with severe leptospirosis, it remains with high mortality. We aimed to identify factors associated with in-hospital mortality among patients with severe leptospirosis admitted to a tertiary intensive care unit.
Methods: We conducted a retrospective cohort study of adults with leptospirosis admitted to the ICU of a tertiary referral hospital in Brazil, between January 1, 2017, and March 3, 2025. Demographic, clinical, laboratory, and intensive care support variables were collected. The primary outcome was in-hospital mortality. Multivariable logistic regression models were used to identify independent predictors of death.
Results: Forty-four patients were included; median age was 42 years, and 95.5% were male. In-hospital mortality was 20.5% (9/44). Severe multiorgan dysfunction was common; 56.8% of patients required renal replacement therapy and invasive mechanical ventilation in 43.2%. In the clinical multivariable model, alveolar hemorrhage (aOR 7.91, 95% CI 1.07–58.61) and arrhythmia (aOR 13.82, 95% CI 2.06–92.64) were independently associated with death. In the laboratory-based model, urea > 180 mg/dL (aOR 9.01, 95% CI 1.36–59.65) and platelet count < 45 × 10³/mm³ (aOR 14.07, 95% CI 1.40–141.88) were independently associated with mortality.
Conclusion: In this contemporary ICU cohort, mortality in severe leptospirosis was primarily driven by respiratory and cardiac complications rather than isolated renal dysfunction. Although renal failure remained a marker of severity, its prognostic impact appeared attenuated by timely renal replacement therapy.
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BibTeX
@article{freitas2026predictors,
title = {{Predictors of in-hospital mortality in severe leptospirosis: a retrospective cohort study (São Paulo, 2017–2025)}},
author = {Jorge Júnior Amorim de Freitas and Diego Diovanny Moraes Polonio Nardotto and Lucas Chaves Netto and Shirley Lopes Dias and Yeh-Li Ho},
journal = {Infection},
year = {2026},
month = jun,
doi = {10.1007/s15010-026-02845-4},
url = {https://doi.org/10.1007/s15010-026-02845-4},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors of in-hospital mortality in severe leptospirosis: a retrospective cohort study (São Paulo, 2017–2025)
AU - Jorge Júnior Amorim de Freitas
AU - Diego Diovanny Moraes Polonio Nardotto
AU - Lucas Chaves Netto
AU - Shirley Lopes Dias
AU - Yeh-Li Ho
PY - 2026
DA - 2026/06/08
JO - Infection
DO - 10.1007/s15010-026-02845-4
UR - https://doi.org/10.1007/s15010-026-02845-4
AB - Purpose: Although advances in intensive care have improved survival of patients with severe leptospirosis, it remains with high mortality. We aimed to identify factors associated with in-hospital mortality among patients with severe leptospirosis admitted to a tertiary intensive care unit. Methods: We conducted a retrospective cohort study of adults with leptospirosis admitted to the ICU of a tertiary referral hospital in Brazil, between January 1, 2017, and March 3, 2025. Demographic, clinical, laboratory, and intensive care support variables were collected. The primary outcome was in-hospital mortality. Multivariable logistic regression models were used to identify independent predictors of death. Results: Forty-four patients were included; median age was 42 years, and 95.5% were male. In-hospital mortality was 20.5% (9/44). Severe multiorgan dysfunction was common; 56.8% of patients required renal replacement therapy and invasive mechanical ventilation in 43.2%. In the clinical multivariable model, alveolar hemorrhage (aOR 7.91, 95% CI 1.07–58.61) and arrhythmia (aOR 13.82, 95% CI 2.06–92.64) were independently associated with death. In the laboratory-based model, urea > 180 mg/dL (aOR 9.01, 95% CI 1.36–59.65) and platelet count < 45 × 10³/mm³ (aOR 14.07, 95% CI 1.40–141.88) were independently associated with mortality. Conclusion: In this contemporary ICU cohort, mortality in severe leptospirosis was primarily driven by respiratory and cardiac complications rather than isolated renal dysfunction. Although renal failure remained a marker of severity, its prognostic impact appeared attenuated by timely renal replacement therapy.
SN - 0300-8126
SN - 1439-0973
ER -