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Does leptospirosis behave adversely in cirrhosis of the liver?

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Abstract

Background and Aim

Leptospirosis, endemic in India, is complicated by jaundice and renal failure. Whether leptospirosis could result in a worsening of preexisting chronic liver disease (CLD) is not known. Aim of the study was to analyze the clinical profile and natural course of leptospirosis in decompensated CLD in comparison to those acquiring the infection in an otherwise healthy individual.

Methods

Cases were patients with liver cirrhosis who presented with fever and/or jaundice and were screened and found positive for leptospirosis. Controls were patients diagnosed to have leptospirosis during the same period, but in the absence of liver disease. Both cases and controls were followed up until recovery or death.

Results

Thirty-one patients had cirrhosis of the liver, and 91 controls had leptospirosis. Significantly more number of cirrhotics had jaundice (87.1 % vs. 16.5 %; p = 0.001), elevated blood urea (41.9 % vs. 18.7 %; p = 0.01), and serum creatinine (41.9 % vs. 19.8 %; p = 0.03) compared to the controls. There were four deaths due to hepatorenal dysfunction and coagulopathy in cirrhotics and no deaths in the control group (4 vs. 0; p = 0.001).

Conclusion

Leptospirosis should be considered as yet another important cause of acute-on-chronic liver failure in endemic areas associated with poor outcome. Death is often due to hepatorenal dysfunction.

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Acknowledgments

The authors wish to acknowledge the contribution of Mr. A. Vengatesan, Statistician, Unit for Evidence-Based Medicine, Madras Medical College, Chennai, for statistical analysis of the data.

Funding

None.

Conflict of interest

AS, NL, JV, SS, and VJ declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights, and the authors followed the policy concerning informed consent as shown in Springer.com.

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Authors and Affiliations

  1. Department of Gastroenterology, Stanley Medical College and Hospital, Chennai, 600 001, India

    Aravindh Somasundaram, Joy Varghese & Venkataraman Jayanthi

  2. Department of Medicine, Stanley Medical College and Hospital, Chennai, 600 001, India

    Nattusamy Loganathan & Singh Shivakumar

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  1. Aravindh Somasundaram
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  2. Nattusamy Loganathan
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  3. Joy Varghese
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  4. Singh Shivakumar
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  5. Venkataraman Jayanthi
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Correspondence to Aravindh Somasundaram.

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Somasundaram, A., Loganathan, N., Varghese, J. et al. Does leptospirosis behave adversely in cirrhosis of the liver?. Indian J Gastroenterol 33, 512–516 (2014). https://doi.org/10.1007/s12664-014-0500-0

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  • DOI: https://doi.org/10.1007/s12664-014-0500-0

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