Leptospirosis in the elderly: the role of age as a predictor of poor outcomes in hospitalized patients

ABSTRACT

Background: The aim of this study was to investigate factors associated with poor outcomes among elderly hospitalized patients with leptospirosis.

Methods: This is a retrospective cohort study with leptospirosis patients admitted to three tertiary hospitals in Fortaleza, Brazil, from January 1985 to July 2017. Patients were divided into two groups: elderly (age ≥60 years) and young (age <60 years). A comparison of demographical, clinical and laboratory data, treatment and outcomes was executed in order to investigate differences between groups.

Results: A total of 507 hospitalized patients were included, with mean age 38 ± 15 years. Elderly group presented lower incidence of myalgia, vomiting, and dyspnea, as well as, higher medium systolic blood pressure. Elderly also manifested higher frequency of AKI (85.9 vs. 74.7%, p = 0.05), hemodialysis requirement (54.7 vs. 37.0%, p = 0.007) and death (32.8 vs. 12.2%, p < 0.001). In multivariate analysis, age ≥60 years was a predictor of hemodialysis requirement (p = 0.008, OR = 2.049, 95% CI = 1.207–3.477) and death (p < 0.001, OR = 3.520, 95% CI = 1.940–6.386).

Conclusion: Leptospirosis in the elderly is associated with less hemodynamic impairment and higher frequency of AKI. Advanced age was also a predictor of poor outcomes, such as hemodialysis requirement and death, mostly due to kidney involvement.

KEYWORDS:

• Leptospirosis
• elderly
• acute kidney injury
• prognosis
• mortality

Acknowledgments

We are very grateful to the team of attendant physicians, residents, medical students and nurses from São José Infectious Diseases Hospital, Walter Cantídio University Hospital and Fortaleza General Hospital for the assistance provided to patients and for the technical support to the development of this research. This research was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq (Brazilian Research Council) and Edson Queiroz Foundation/University of Fortaleza.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (BR) [405963/2016-5].