Revista Cubana de Medicina (Aug 2004)
Comportamiento de la leptospirosis grave en la unidad de cuidados intensivos Behavior of severe leptospirosis at the intensive care unit
Abstract
Se describió el comportamiento de la leptospirosis grave en 35 pacientes ingresados en la Unidad de Cuidados Intensivos de Adultos del Instituto de Medicina Militar "Dr. Luis Díaz Soto." Se recogieron los datos de las historias clínicas de los afectados con este diagnóstico comprobado por pruebas serológicas. Se realizó análisis univariado para cada variable mediante la prueba de la t de Student y de Chi cuadrado. Se usó el método de regresión logística para determinar factores asociados a la mortalidad. El 20 % de las personas con leptospirosis grave falleció, no se halló relación significativa de la tenencia de animales o vivir en zona rural con respecto a la mortalidad. Se comprobó el 71,4 % de errores diagnósticos en el grupo de fallecidos, el principal fue la sepsis urinaria. Los factores pronósticos de mayor relación con la mortalidad (p The behavior of severe leptospirosis in 35 patients admitted at the Adults' Intensive Care Unit of "Dr. Luis Díaz Soto" Institute of Military Medicine was described. Data were taken from the medical records of those patients, whose diagnosis had been confirmed by serological tests. Univariate analysis was made for each variable by Student's t test and Chi square test. The logistical regression method was used to determine factors associated with mortality. 20 % of the persons with severe leptospirosis died .No significant relation was found between having animals, or living in a rural area and mortality. 71.4 % of the diagnositc errors in the group of deaths were proved. Urinary sepsis was the main of them. The prognostic factors showing the highest relation with mortality (p < 0.05; 95 % of confidence) were: a) days of onset of the symptoms, b) stay at the AICU, c) ratio PO2/FiO2, f) APACHE II value, g) requirement of inotropic drugs, h) presence of acute renal failure. i) existance of coagulopathies, j) demand of globules transfusions, k) need of extrarenal depuration, l) manifestations of multiple organ dysfunction. It was concluded that leptospirosis behaved as a medical emergency and that the severe patient care service should give it an appropriate attention.
