Leptospirosis in ICU: A Retrospective Study of 134 Consecutive Admissions

Objectives: Leptospirosis causes reversible multiple organ failure, and its mortality remains high. The aim of this study was to determine the mortality rate of leptospirosis in an ICU offering all types of organ support available nowadays and to compare it with mortality in bacterial sepsis. Design: Retrospective, descriptive, and single-center cohort study. Settings: The largest ICU of Reunion Island (Indian Ocean) in a teaching hospital. Patients: Consecutive patients hospitalized in ICU for leptospirosis from January 2004 to January 2015. Interventions: None. Measurements and Main Results: We report 134 cases of patients with leptospirosis hospitalized in ICU. The median age was 40 years (interquartile range, 30–52 yr), with a Simplified Acute Physiology Score II of 38 (27–50) and a Sequential Organ Failure Assessment score of 10 (8–12). Forty-one patients (31%) required mechanical ventilation and 76 (56%) required renal replacement therapy. The door-to-renal replacement therapy time was 0 (0–1) day after admission with a median urea of 25 mmol/L (17–32 mmol/L). Five patients required extracorporeal membrane oxygenation. The mortality rate was 6.0% (95% CI, 2.6–11.4). Among patients hospitalized for sepsis, the standardized mortality ratio of patients with leptospirosis with regards to Simplified Acute Physiology Score II was dramatically low: 0.40 (95% CI, 0.17 – 0.79). Conclusions: The mortality of severe leptospirosis is lower than for other bacterial infection, provided modern resuscitation techniques are available. Prompt organ support ensures very low mortality rates despite high severity scores.