INITIAL SYMPTOMATOLOGY AS A PREDICTOR OF CLINICAL OUTCOME IN LEPTOSPIROSIS: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Leptospirosis presents with a wide, non-specific symptom spectrum that delays diagnosis. Identifying which presenting features carry prognostic weight could support earlier triage.

Methods: In this prospective, single-centre observational study conducted over 24 months (2018–2020), 85 patients aged 18–70 years with leptospirosis diagnosed by modified Faine's criteria were enrolled. Presenting symptoms and admission clinical signs were recorded and related to bleeding manifestation and in-hospital outcome. Proportions were compared using Fisher's exact test.

Results: Overall in-hospital mortality was 27.1% (23/85). Fever (85.9%), myalgia (80.0%) and chills or rigors (78.8%) were commonest but did not discriminate outcome. Four features identified subgroups with higher mortality: altered sensorium (20/23, 87.0% versus 4.8% in its absence; odds ratio [OR] 112.8, 95% confidence interval [CI] 20.4–986.0), abdominal pain (23/32, 71.9% versus 0%; OR not estimable, lower bound 26.0), breathlessness or cough (19/34, 55.9% versus 7.8%; OR 14.3, 95% CI 4.0–67.1) and jaundice (16/32, 50.0% versus 13.2%; OR 6.4, 95% CI 2.1–22.1); p<0.001 for all four. Altered sensorium had the highest positive predictive value (87.0%), while abdominal pain, present in every patient who died, had a negative predictive value of 100%. All four overlapped substantially with bleeding manifestations (67.6–81.3%).

Conclusion: Fever, myalgia and chills dominate the presenting picture of leptospirosis but do not discriminate outcome. Altered sensorium, abdominal pain, breathlessness or cough and jaundice each identified a subgroup at substantially higher risk of death and should be treated as red-flag features at first contact. Their close overlap with bleeding suggests they mark an underlying severe multisystem process rather than acting independently.