Outcome of severe leptospirosis presenting with ARDS in respiratory ICU

Abstract

Introduction: Acute Respiratory Distress Syndrome (ARDS) is a rare presentation and a major complication of leptospirosis associated with high mortality despite advances in management. Methods: We conducted a retrospective observational study, in 48 patients presenting with ARDS due to leptospirosis. Clinical presentation, risk factors, management and outcome of patients were noted. Factors associated with survival and mortality were studied. Results: Our study showed a male preponderance (87%) with a mean age of presentation of 31.5 years. All patients presented with multiorgan failure. PaO2/FiO2 ratio less than 100 on 3rd day was associated with 90% mortality. The requirement for invasive mechanical ventilation carried a mortality risk of 70.4%. Overall mortality was 39.6%. Conclusion: Leptospirosis can cause serious ARDS with a high case fatality. Prompt treatment with non-invasive mechanical ventilation to maintain haemodynamic stability and intravenous steroids can improve the outcome.