Kidney Week

Abstract: PUB055

Oliguria in Leptospirosis-Associated AKI Is Associated with Worse Outcomes: A Study Based on Novel Prognostic Score System

Session Information

• Publication Only

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Diniz, Renan Gomes Mendes, Universidade de Sao Paulo, Sao Paulo, Brazil

Renan Gomes Mendes Diniz, MD

• Neto, Luiz Paulino Gomes, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Luiz Paulino Gomes Neto

• Domingues da Silva, Raoni de Oliveira, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Raoni de Oliveira Domingues da Silva

• De Araujo, Leticia Machado, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Leticia Machado De Araujo, PharmD

• Meneses, Gdayllon Cavalcante, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Gdayllon Cavalcante Meneses, PhD

• Galdino, Gabriela, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Gabriela Galdino, PhD

• Silva Junior, Geraldo B., Universidade de Fortaleza, Fortaleza, CE, Brazil

Geraldo B. Silva Junior, MD, PhD

• Martins, Alice Costa, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Alice Costa Martins, PhD

• Daher, Elizabeth De Francesco, Universidade Federal do Ceara, Fortaleza, Ceará, Brazil

Elizabeth De Francesco Daher, MD, PhD

Background

Leptospirosis (LPT) is a neglected tropical zoonosis, with high incidence in some regions of the world. Its severe forms manifest with acute kidney injury (AKI) and lung hemorrhage, associated with systemic inflammatory response and high mortality rates. Prognostic scores and early identification of AKI and endothelial biomarkers have been the subject of recent studies. This study aimed to evaluate the association between oliguric and non-oliguric LPT with clinical scores and endothelial and AKI biomarkers.

Methods

This prospective study incçuded patients with LPT admitted in three hospitals in Brazil. Patients were divided into two groups: those with oliguria (O), and without oliguria (NO). Clinical data, blood, and urine samples were obtained and clinical scores applied. A specific prognostic score system for leptospirosis prognosis was used (QUICK-LEPTO - a new validated score that involves age, lethargy, tachypnea, blood pressure and hematocrit), as well as SOFA (sequential organ failure assessment) score.

Results

Among the total of 44 patients, 81.8% were male. Average age was 40.8 years. Creatinine level was 3.9mg/dL in O vs 2.1mg/dL in NO (p=0.2). Mortality rate was 18% in O and 6.1% in NO (p=0.3). Hemoptysis was more prevalent in O (27% vs. 3%; p-0.043). The QUICK-LEPTO score was worse in O patients (median score 3 vs. 2; p=0.03), while the QUICK-SOFA surprisingly showed no significant difference between the groups. Biomarkers V-CAM, I-CAM, FGF23, Ang1, MCP-1 did not differ significantly between the groups. Syndecan, was higher in O group (774 ± 424 ng/mL vs. 419 ± 380 ng/mL, p = 0.037). NGAL was higher in QLEPTO scores 2 to 6 in O group (472±21 vs. 370±93; p=0,03).

Conclusion

This study indicates that oliguric LPT patients had more hemoptysis and worse results in QLEPTO, despite no differences in QSOFA. QLEPTO is emerging as a new valuable score also for association with some organ injury biomarkers. Further studies with larger samples can help to elucidate more valuable parameters and biomarkers associated with oliguric AKI in LPT aiming to identify early cases with poor prognosis, aiding the early introduction of clinical management.