Pulmonary involvement predicts mortality in severe leptospirosis patients.

Aim: to evaluate the influence of pulmonary involvement at admission in predicting mortality among patients with severe leptospirosis. Methods: reprospective cohort study from medical record registry in Dr. Sardjito Hospital, Yogyakarta from 2003 to 2007. Pulmonary involvement was defined by the presence of pulmonary infiltrate, consolidation or pleural effusion in thorax radiography. Pulmonary edema was excluded. Admission data were collected. Follow-up records were noted until patients were discharded or died. The correlation between predictors (some patient characteristics on admission) and outcome (mortality) were evaluated using univariate analysis, and then proceeded to multivariable logistic regression analysis. P < 0.05 is considered statistically significant. Results: sixty patients with severe leptospirosis as a main diagnosis were evaluated. Fifty-five subjects were eligible for analysis, male patients 37 (67.3%) and mean age 42 +/- 15 years old. Pulmonary involvement was presence in 7 patients (12.7%). In univariate analysis only the presence of meningismus and pulmonary involvement were associated with mortality (p=0.001 and 0.006 respectively). In multivariable logistic regression, pulmonary involvement was independently a strong predictor of mortality (OR 9.9 95% CI (1.17 - 84.03), p=0.035). Conclusion: pulmonary involvement at admission is a strong predictor of mortality among patients with severe leptospirosis.

Total lymphocyte count and hemoglobin combined to predict CD4 lymphocyte counts of less than 200 cells/mm(3) in HIV/AIDS.

AIM: to obtain the sensitivity and specificity of combining total lymphocyte count and hemoglobin to predict the CD4 lymphocyte count below 200 cells/m3. METHODS: this is a cross sectional study. Subject characteristics were patient with HIV/AIDS who have not been initiated ARV therapy, the age above 15 years, have a CD4 lymphocyte count data. A total of 72 patients were recruited from clinic of Edelweis or hospitalized patients at Dr. Sardjito Hospital Yogyakarta in March 2002 - March 2007. Independent t test and Mann-Whitney test was used to find out the differences of continue variable. P < or = 0.05 was considered significant. RESULTS: a total of 72 patients were studied. Of these,50 patients (69.4%) were male, 22 patients (30.6%) were female. 53 patients with CD4 below 200 cells/mm3 and 19 patients with CD4 above 200 cells/mm3. Mean of TLCin HIV/AIDS patients with CD4 below 200 cells/mm3 were: 1013.24+/- 96.06 and CD4 above 200 cells/mm3 were 2161.36 +/- 214.66. Mean of Hb in HIV/AIDS patients with CD4 below 200 cells/mm3 were: 11.61+/- 0.30 and CD4 above 200 cells/mm3 were 12.47 +/- 0.59.Sensitivity of combined TLC+Hb man (algorithms a,b) were 80.95%, 88.09% Vs TLC 66.66%; Sensitivity of combined TLC+Hb woman (algorithms a, b) were 54.54%,54.54% Vs TLC 54.54%; Specificity of combined TLC+Hbman (algorithms a, b) were 87.50%, 87.50% Vs TLC 87.50%; Specificity of combined TLC+Hb woman (algorithms a, b)were 63.63%, 54.54% Vs TLC 90.90%. CONCLUSION: adding hemoglobin to TLC (algorithms aand b in man) increased sensitivity, there by reducing the risk of false-negative results.