Title : Incidence of acute pancreatitis among patients with moderate to severe leptospirosis and its clinical outcomes: A single center retrospective study in a tertiary hospital
Abstract:
Introduction: Acute pancreatitis is considered as an uncommon complication of leptospirosis. However, literatures suggested that this condition still occurs among leptospirosis patients. This study aims to determine the incidence of acute pancreatitis in moderate to severe leptospirosis cases and its clinical outcomes in patients admitted in a tertiary hospital.
Methodology: This was a cross-sectional study which utilized retrospective records review. Data on incidence of acute pancreatitis, clinical signs, laboratory parameters, and outcomes were collected from medical charts of eligible patients.
Results: The incidence of acute pancreatitis in severe leptospirosis cases was found to be 71.2% (n=47/66, 95%CI=59.5% to 81.2%). Among those with acute pancreatitis, mortality rate was 21.3% (n=10/47, 95%CI=11.4% to 34.7%). The most common clinical presentations were abdominal pain (95.7%), renal failure (91.49%), thrombocytopenia (76.6%), jaundice (74.47%), and respiratory symptoms (27.66%). The median total bilirubin was significantly higher among those who expired (10mg/dl) than those who survived (5mg/dl) (p=0.036). The median amylase was significantly higher among those who expired (686 U/L) than those who survived (454 U/L) (p=0.029). The odds ratio for mortality associated with having acute pancreatitis was 2.297 (95%CI=0.453 to 11.640) (p=0.335). Patients with dyspnea/hemoptysis as clinical data are 12.056 times more likely to expire (p=0.002). For every mg/dl increase in patient’s total bilirubin, the odds of mortality also increase by 18.16% (p=0.041). For every U/L increase in amylase, the odds of mortality also increase by 0.37% (p=0.024). Patients with Acute respiratory distress syndrome as a complication are 12.056 times more likely to expire (p=0.002).
Conclusion: This study observed a high incidence of acute pancreatitis in severe leptospirosis. About one fifth of acute pancreatitis result in mortality. Significant predictors of mortality in patients with severe leptospirosis and acute pancreatitis include dyspnea/hemoptysis, increased total bilirubin, increased amylase, and acute respiratory distress syndrome. Given the serious consequence of acute pancreatitis, clinicians should watch-out and plan for this complication. Future studies with larger sample size are needed to validate our findings.
