“Descriptive Study of the Outcome of Leptospirosis at the Adult Intensive Care Unit, Colonial War Memorial Hospital, Suva- A Retrospective Study” (January 1st 2008- December 31st 2017)

Researchers: Seru MV, Bennett EJ
Key Words: Leptospirosis, mortality, CWMH ICU
Introduction: Leptospirosis is a major Public health concern in Fiji. Anecdotal evidence from older unpublished studies of leptospirosis in Fiji suggests that the mortality for Leptospirosis cases once admitted into the Intensive Care Unit (ICU) is close to 100%. In recent years, there has been a noticeable rise in cases of Leptospirosis getting discharged from the CWMH ICU to the general medical ward however ICU admission, survival and discharge rates have never been documented. This warranted a descriptive study to document the Outcome of Leptospirosis at the Adult Intensive Care Unit, CWMH, Suva, Fiji.
Method: This was to be a cross-sectional study from January 1st 2008 to December 31st 2017, however due to missing ICU admission records prior to July 2010, the study was carried out from July 1st 2010 to December 31st 2017. For a sample size of 73 patients, information on demographics, clinical variables, symptom duration, treatment variables and severity scoring was entered into data extraction forms then transferred into Microsoft Excel for data analysis. Data analysis was done using microsoft excel and statististical analysis in SPSS used chi square to show relation between two categorical variables. A p value of <0.05 in this research shows statistical significance.
Results: Cases were mainly in the16-45yrs age group. Males (71.23%) were found to be affected more frequently than females (28.77%). Itaukei (85%) ethnic group comprised the majority of cases. The case fatality rates from Leptospirosis in CWMH ICU were 100% in 2010 and 14% in 2017 while the Mean SOFA score was on average 16 in 2010 and 13 in 2017. The actual mortality has been less than the predicted mortality by SOFA score since 2015. In terms of Demographics, Age, Gender and Ethnicity were not significantly associated with mortality. In terms of treatment factors, hemodialysis, antibiotics and blood transfusion were shown to improve outcome. Analysis on the use of steroids showed that for those who didn’t receive any kind of steroid, more survived (68.42%). However, due to low sample number, all of the treatment associations to outcome were not statistically significant. Pulmonary Hemorrhage on the other hand was a statistically significant (p= 0.029) risk factor for mortality with a case fatality rate of 49.25% over the study period.
Conclusion: The case fatality rates for Leptospirosis cases admitted into CWMH ICU has decreased over the years, which shows that the overall outcome of leptospirosis cases admitted into CWMH ICU has improved. This may be attributable to the improvement in the standard and quality of care.
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