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Predictors of Lethality in Severe Leptospirosis in Urban Brazil

Anne S. SpichlerHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Pedro J. VilaçaHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Daniel A. AthanazioHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Jose O. M. AlbuquerqueHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Marcia BuzzarHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Bronislawa CastroHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Antonio SeguroHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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Joseph M. VinetzHealth Municipality Secretariat of São Paulo, São Paulo, Brazil; Department of Nephrology–LIM 12, University of São Paulo School of Medicine, Brazil; Federal University of Bahia, Brazil; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

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To ascertain prognostic factors associated with fatal outcomes in severe leptospirosis, a retrospective case-control study was done using population-based surveillance data. Centralized death certificate reporting of leptospirosis mortality was combined with details of patients’ hospitalizations, which were obtained from hospitals representing all sectors of São Paulo city. Among identified leptospirosis cases, 89 lethal cases and 281 survivor cases were analyzed. Predictors of death included age > 40 years, development of oliguria, platelet count < 70,000/μL, creatinine > 3 mg/dL, and pulmonary involvement. The latter was the strongest risk factor with an estimated odds ratio of 6.0 (95% confidence interval: 3.0–12.0). Serologic findings with highest titer against Leptospira interrogans serovar Copenhageni did not show significant differences between survivors and non-survivors. Lung involvement was an important predictor of death in leptospirosis in São Paulo, of relevance in leptospirosis-endemic regions where this complication is common.

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