| Summary: | Background: This study was conducted to investigate factors associated with thrombocytopenia in a large cohort of patients with leptospirosis in an endemic area.
Patients and Methods: This is a retrospective study including 374 consecutive patients with leptospirosis admitted to tertiary hospitals in Fortaleza, Brazil. All patients had diagnosis of leptospirosis, and acute kidney injury (AKI) was defined according to the RIFLE criteria. Thrombocytopenia was defined as platelets count lower than 100,000/mm3.
Results: A total of 374 patients were included, with a mean age of 36.1±15.5 years, and 83.4% were male. Thrombocytopenia was present at hospital admission in 200 cases (53.5%) and developed during hospital stay in 150 cases (40.3%). Patients with thrombocytopenia had a higher frequency of dehydration (53% vs. 35.3%, p=0.001), epistaxis (5.7% vs. 0.8%, p=0.033), hematemesis (13% vs. 4.6%, p=0.006), myalgia (91.5% vs. 84.5%, p=0.038), hematuria (54.8% vs. 37.6%, p=0.011), metabolic acidosis (18% vs. 9.2%, p=0.016) and hypoalbuminemia (17.8% vs. 7.5%, p=0.005). Independent risk factors associated with thrombocytopenia during hospital stay were length of disease (OR: 1.2, p=0.001) and AKI (OR: 6.6, p=0.004). Mortality was not associated with thrombocytopenia at admission (12.5% vs. 12.6%, p=1.000) or during hospital stay (12.6% vs. 11.3%, p=0.748).
Conclusions: Thrombocytopenia is a frequent complication in leptospirosis, which was present in more than half of patients at hospital admission. The length of disease and AKI are risk factors for thrombocytopenia. There was no significant association between thrombocytopenia and mortality. Advanced age and oliguria were independent risk factors for death.
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