{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:27:56Z","timestamp":1793647676799,"version":"4.5.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universidade De S\u00e3o Paulo","id":[{"id":"https:\/\/ror.org\/036rp1748","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Although advances in intensive care have improved survival of patients with severe leptospirosis, it remains with high mortality. We aimed to identify factors associated with in-hospital mortality among patients with severe leptospirosis admitted to a tertiary intensive care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of adults with leptospirosis admitted to the ICU of a tertiary referral hospital in Brazil, between January 1, 2017, and March 3, 2025. Demographic, clinical, laboratory, and intensive care support variables were collected. The primary outcome was in-hospital mortality. Multivariable logistic regression models were used to identify independent predictors of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-four patients were included; median age was 42 years, and 95.5% were male. In-hospital mortality was 20.5% (9\/44). Severe multiorgan dysfunction was common; 56.8% of patients required renal replacement therapy and invasive mechanical ventilation in 43.2%. In the clinical multivariable model, alveolar hemorrhage (aOR 7.91, 95% CI 1.07\u201358.61) and arrhythmia (aOR 13.82, 95% CI 2.06\u201392.64) were independently associated with death. In the laboratory-based model, urea\u2009&gt;\u2009180\u00a0mg\/dL (aOR 9.01, 95% CI 1.36\u201359.65) and platelet count\u2009&lt;\u200945\u2009\u00d7\u200910\u00b3\/mm\u00b3 (aOR 14.07, 95% CI 1.40\u2013141.88) were independently associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this contemporary ICU cohort, mortality in severe leptospirosis was primarily driven by respiratory and cardiac complications rather than isolated renal dysfunction. Although renal failure remained a marker of severity, its prognostic impact appeared attenuated by timely renal replacement therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02845-4","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T13:22:11Z","timestamp":1780924931000},"page":"2377-2387","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of in-hospital mortality in severe leptospirosis: a retrospective cohort study (S\u00e3o Paulo, 2017\u20132025)"],"prefix":"10.1007","volume":"54","author":[{"given":"Jorge J\u00fanior Amorim","family":"de Freitas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego Diovanny Moraes Polonio","family":"Nardotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Chaves","family":"Netto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley Lopes","family":"Dias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeh-Li","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"2845_CR1","doi-asserted-by":"publisher","unstructured":"Costa F, Hagan JE, Calcagno J, et al. Global morbidity and mortality of leptospirosis: a systematic review. PLoS Negl Trop Dis. 2015;9. https:\/\/doi.org\/10.1371\/journal.pntd.0003898.","DOI":"10.1371\/journal.pntd.0003898"},{"key":"2845_CR2","doi-asserted-by":"publisher","unstructured":"Karpagam KB, Ganesh B. Leptospirosis: a neglected tropical zoonotic infection of public health importance\u2014an updated review. Eur J Clin Microbiol Infect Dis. 2020;39. https:\/\/doi.org\/10.1007\/s10096-019-03797-4.","DOI":"10.1007\/s10096-019-03797-4"},{"key":"2845_CR3","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade S de V em S e A. Guia de vigil\u00e2ncia em sa\u00fade. 2024; 3."},{"key":"2845_CR4","doi-asserted-by":"publisher","unstructured":"Bharti AR, Nally JE, Ricaldi JN, et al. Leptospirosis: A zoonotic disease of global importance. Lancet Infect Dis. 2003;3. https:\/\/doi.org\/10.1016\/S1473-3099(03)00830-2.","DOI":"10.1016\/S1473-3099(03)00830-2"},{"key":"2845_CR5","doi-asserted-by":"publisher","unstructured":"Carvalho CRR, Bethlem EP. Pulmonary complications of leptospirosis. Clin Chest Med. 2002;23. https:\/\/doi.org\/10.1016\/S0272-5231(01)00010-7.","DOI":"10.1016\/S0272-5231(01)00010-7"},{"key":"2845_CR6","doi-asserted-by":"publisher","unstructured":"Segura ER, Ganoza CA, Campos K, et al. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiral burden. Clin Infect Dis. 2005;40. https:\/\/doi.org\/10.1086\/427110.","DOI":"10.1086\/427110"},{"key":"2845_CR7","doi-asserted-by":"publisher","unstructured":"Chierakul W, Tientadakul P, Suputtamongkol Y, et al. Activation of the coagulation cascade in patients with leptospirosis. Clin Infect Dis. 2008;46. https:\/\/doi.org\/10.1086\/524664.","DOI":"10.1086\/524664"},{"key":"2845_CR8","doi-asserted-by":"publisher","unstructured":"Sethi A, Kumar TP, Vinod KS, et al. Kidney involvement in leptospirosis: a systematic review and meta-analysis. Infection. 2025;53. https:\/\/doi.org\/10.1007\/s15010-025-02492-1.","DOI":"10.1007\/s15010-025-02492-1"},{"key":"2845_CR9","doi-asserted-by":"publisher","unstructured":"Andrade L, Cleto S, Seguro AC. Door-to-dialysis time and daily hemodialysis in patients with leptospirosis: Impact on mortality. Clin J Am Soc Nephrol. 2007;2. https:\/\/doi.org\/10.2215\/CJN.00680207.","DOI":"10.2215\/CJN.00680207"},{"key":"2845_CR10","doi-asserted-by":"publisher","unstructured":"Spichler AS, Vila\u00e7a PJ, Athanazio DA, et al. Predictors of lethality in severe leptospirosis in urban Brazil. Am J Trop Med Hyg. 2008;79. https:\/\/doi.org\/10.4269\/ajtmh.2008.79.911.","DOI":"10.4269\/ajtmh.2008.79.911"},{"key":"2845_CR11","doi-asserted-by":"publisher","unstructured":"Dupont H, Dupont-Perdrizet D, Perie JL, Zehner-Hansen S, Jarrige B, Daijardin JB. Leptospirosis: Prognostic factors associated with mortality. Clin Infect Dis. 1997;25. https:\/\/doi.org\/10.1086\/513767.","DOI":"10.1086\/513767"},{"key":"2845_CR12","doi-asserted-by":"publisher","unstructured":"Panaphut T, Domrongkitchaiporn S, Thinkamrop B. Prognostic factors of death in leptospirosis: A prospective cohort study in Khon Kaen, Thailand. Int J Infect Dis. 2002;6. https:\/\/doi.org\/10.1016\/S1201-9712(02)90137-2.","DOI":"10.1016\/S1201-9712(02)90137-2"},{"key":"2845_CR13","doi-asserted-by":"publisher","unstructured":"Delmas B, Jabot J, Chanareille P, et al. Leptospirosis in ICU: a retrospective study of 134 Consecutive Admissions. 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Determinants of prolonged hospitalization and mortality among leptospirosis patients attending tertiary care hospitals in northeastern state in peninsular Malaysia: A cross sectional retrospective analysis. Front Med (Lausanne). 2022;9. https:\/\/doi.org\/10.3389\/fmed.2022.887292.","DOI":"10.3389\/fmed.2022.887292"},{"key":"2845_CR17","doi-asserted-by":"publisher","unstructured":"Milovanovic L, Singh G, Townsend D, Nagendran J, Sligl W. Extracorporeal life support for severe leptospirosis: Case series and narrative review. J Association Med Microbiol Infect Disease Can. 2024;9. https:\/\/doi.org\/10.3138\/jammi-2023-0033.","DOI":"10.3138\/jammi-2023-0033"},{"key":"2845_CR18","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.3390\/pathogens14121268","volume":"14","author":"P Rosengren","year":"2025","unstructured":"Rosengren P, Johnston L, Ismail I, Smith S, Hanson J. The characteristics of patients that develop severe leptospirosis: a scoping review. Pathogens. 2025;14:1268.","journal-title":"Pathogens"},{"key":"2845_CR19","doi-asserted-by":"publisher","unstructured":"Fonseka CL, Dahanayake NJ, Mihiran DJD, et al. Pulmonary haemorrhage as a frequent cause of death among patients with severe complicated Leptospirosis in Southern Sri Lanka. PLoS Negl Trop Dis. 2023;17. https:\/\/doi.org\/10.1371\/journal.pntd.0011352.","DOI":"10.1371\/journal.pntd.0011352"},{"key":"2845_CR20","doi-asserted-by":"publisher","unstructured":"Nisansala GGT, Weerasekera M, Ranasinghe N, et al. Predictors of severe leptospirosis on admission: a sri lankan study . 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The study was approved by the Research Ethics Committee of the Hospital das Cl\u00ednicas, Faculdade de Medicina, University of S\u00e3o Paulo (CAAE 89781925.1.0000.0068).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived because of the retrospective design and exclusive use of medical record data. Participant anonymity was preserved.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this manuscript, generative artificial intelligence tools were used to assist with grammar, clarity, and language editing. The authors critically reviewed and edited the content and take full responsibility for the accuracy, integrity, and final version of the manuscript.","order":4,"name":"Ethics","label":"Artificial intelligence","group":{"name":"EthicsHeading","label":"Declarations"}}]}}