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A Diagnostic scoring model for Leptospirosis in resource limited settings

Show simple item record Rajapakse, S. en_US Weeratunga, P. en_US Niloofa, R. en_US Fernando, N. en_US de Silva, N.L. en_US Rodrigo, C. en_US Maduranga, S. en_US Nandasiri, N. en_US Premawansa, S. en_US Karunanayake, L. en_US de Silva, H.J. en_US Handunnetti, S. en_US 2016-06-28T09:26:38Z en_US 2016-06-28T09:26:38Z en_US 2016 en_US
dc.identifier.citation PLoS Neglected Tropical Diseases. 2016; 10(6): e0004513 en_US
dc.identifier.issn 1935-2735(Electronic) en_US
dc.identifier.issn 1935-2727(Print) en_US
dc.identifier.uri en_US
dc.description Indexed in MEDLINE en
dc.description.abstract Leptospirosis is a zoonotic infection with significant morbidity and mortality. The clinical presentation of leptospirosis is known to mimic the clinical profile of other prevalent tropical fevers. Laboratory confirmation of leptospirosis is based on the reference standard microscopic agglutination test (MAT), direct demonstration of the organism, and isolation by culture and DNA detection by polymerase chain reaction (PCR) amplification. However these methods of confirmation are not widely available in resource limited settings where the infection is prevalent, and reliance is placed on clinical features for provisional diagnosis. In this prospective study, we attempted to develop a model for diagnosis of leptospirosis, based on clinical features and standard laboratory test results. METHODS: The diagnostic score was developed based on data from a prospective multicentre study in two hospitals in the Western Province of Sri Lanka. All patients presenting to these hospitals with a suspected diagnosis of leptospirosis, based on the WHO surveillance criteria, were recruited. Confirmed disease was defined as positive genus specific MAT (Leptospira biflexa). A derivation cohort and a validation cohort were randomly selected from available data. Clinical and laboratory manifestations associated with confirmed leptospirosis in the derivation cohort were selected for construction of a multivariate regression model with correlation matrices, and adjusted odds ratios were extracted for significant variables. The odds ratios thus derived were subsequently utilized in the criteria model, and sensitivity and specificity examined with ROC curves. RESULTS: A total of 592 patients were included in the final analysis with 450 (180 confirmed leptospirosis) in the derivation cohort and 142 (52 confirmed leptospirosis) in the validation cohort. The variables in the final model were: history of exposure to a possible source of leptospirosis(adjusted OR = 2.827; 95% CI = 1.517-5.435; p = 0.001) serum creatinine > 150 micromol/l (adjusted OR = 2.735; 95% CI = 1.374-4.901; p = 0.001), neutrophil differential percentage > 80.0% of total white blood cell count (adjusted OR 2.163; 95% CI = 1.309-3.847; p = 0.032), serum bilirubin > 30 micromol/l (adjusted OR = 1.717; 95% CI 0.938-3.456; p = 0.049) and platelet count < 85,000/mm3 (adjusted OR = 2.350; 95% CI = 1.481-4.513; p = 0.006). Hosmer-Lemeshow test for goodness of fit was 0.931. The Nagelkerke R2 was 0.622. The area under the curve (AUC) was noted as 0.762. A score value of 14 reflected a sensitivity of 0.803, specificity of 0.602, a PPV of 0.54, NPV of 0.84, a positive LR of 2.01 and a negative LR of 0.32. CONCLUSIONS: The above diagnostic model for diagnosis of leptospirosis is suggested for use in clinical settings. It should be further validated in clinical practice. en_US
dc.language.iso en_US en_US
dc.publisher Public Library of Science en_US
dc.subject Leptospirosis en_US
dc.subject.mesh Leptospirosis-diagnosis en_US
dc.subject.mesh Leptospirosis-pathology en_US
dc.subject.mesh Zoonoses en_US
dc.subject.mesh Biomarkers-blood en_US
dc.subject.mesh Clinical Laboratory Techniques en_US
dc.subject.mesh Risk Factors en_US
dc.subject.mesh Sensitivity and Specificity en_US
dc.subject.mesh Sri Lanka-epidemiology en_US
dc.title A Diagnostic scoring model for Leptospirosis in resource limited settings en_US
dc.type Article en_US

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