Critically ill patients with leptospirosis have been found to display primarily hypokinetic hemodynamics, which are further complicated by myocarditis, arrhythmias, pulmonary involvement, shock and renal failure. Hemodynamic monitoring of these patients would help in better understanding of pathophysiology of this disease. Possible correlations with morbidity and mortality patterns could be established.
After the Institutional Ethics Committee permission, 17 patients admitted to the Medical Intensive Care Unit of KEM Hospital, Mumbai, clinically diagnosed with leptospirosis (Faine's criteria) were recruited for the study. Clinical and biochemical profiles were documented. As per protocol, hemodynamic variables were measured using a Swan-Ganz pulmonary catheter and a computerized multiparameter monitor within 48 hours of admission.The data was compared using Mann-Whitney test to correlate the morbidity and mortality between the survivors and non-survivors.
We found two hemodynamic patterns- respiratory failure with left ventricular dysfunction (LVD) (n = 1) and respiratory failure without left ventricular dysfunction (n = 16). Among these, there were 7 survivors and 9 non-survivors. Both the groups without LVD showed a pattern like septic shock, with low systemic vascular resistance index (SVRI), normal to high cardiac index, normal pulmonary wedge pressure, but a variable pulmonary vascular resistance index (PVRI) and mean pulmonary artery pressure (MPAP). The mean pulmonary arterial pressure of survivors was significantly lesser as compared to the non survivors (P = 0.007). The median PVRI of the non-survivors was much higher (281) as compared to the survivors (192). These could be important prognostic factors for determining survival in critically ill patients with leptospirosis.
Critically ill patients with leptospirosis present predominantly with septic shock. Occasional cardiac involvement leads to a pattern of cardiogenic shock. The MPAP and PVRI of non-survivors were higher than that of survivors, which could suggest a role of irreversible lung injury as a predictor of mortality in these patients.
As the patterns of shock in patients with leptospirosis vary, early identification of these patterns can help in earlier interventions which may help in preventing mortality.
Hrishikesh Kulkarni, No Financial Disclosure Information; No Product/Research Disclosure Information