Organ malfunctions in patients with leptospirosis have been associated with the bacterial glycolipoprotein endotoxin and with its nonesterified unsaturated fatty acid (NEUFA) components. We examined the involvement of NEUFAs in the pathophysiological processes of leptospirosis. Patients showed a moderate increase in serum concentrations of oleic and linoleic acids but an important decrease in serum concentrations of albumin. A highly significant correlation between serum concentrations of creatinine or total bilirubin and the oleic-plus-linoleic acid : albumin ratio was revealed. We used the Na(+),K(+)-ATPase inhibitory property of NEUFAs to test the capacity of serum to prevent the cytotoxic effects of NEUFAs in vitro. Albumin solutions and serum samples from healthy volunteers, but not serum samples from severely affected patients, were able to revert the Na(+),K(+)-ATPase inhibition by oleic acid. On the basis of these data, we defined a "serum protection factor" that can be helpful in predicting NEUFA toxicity. Our data support the concept that the administration of human albumin to patients may be helpful in severe leptospirosis cases.

Human leptospirosis is an acute infectious zoonosis presenting specific lipid disorders. Previous in vitro studies showed both leptospira glycolipoprotein endotoxin, and high oleic acid levels were associated with Na/K-ATPase inhibition that is amplified by the reduction of circulating albumin levels. In this study, we aimed to investigate the relationship of oleic acid/albumin (OA/A) molar ratio and clinical outcomes in Leptospirosis. Through a prospective observational cohort study employing high-performance liquid chromatography (HPLC) we sequentially determined serum concentrations of nonesterified fatty acids (NEFA) and albumin in twenty-eight patients with severe leptospirosis since their hospital admission. Twenty patients recovered, and eight died. Data was distributed in two groups according to clinical outcomes. Oleic acid/albumin molar ratios (OA/A), initial samples, were higher than those in healthy donors. The ratio OA/A, however, persisted high in dying patients, whereas patients who survived had a reduction matching to healthy donors. Biochemical alterations suggest that cure is correlated to the reestablishment of the OA/A molar ratio, while fatal outcomes related to persisting OA/A imbalances. Analysis by receiver operating characteristic (ROC) showed the area under the curve of 0.864 and the cutoff value of 0.715 being associated with a high odds ratio. Lipid analysis from patients with leptospirosis had an acute high serum OA/A molar ratio, and sustained imbalance has a high odds ratio and strong correlation with mortality.