Leptospirosis presents a significant health challenge in the Transcarpathian region of Ukraine, with higher incidence rates and mortality compared to national averages. We conducted a retrospective cohort study to investigate the effects of antibiotic and steroid treatments on outcomes in leptospirosis patients. Our analysis of clinical and laboratory data from a single center revealed that dexamethasone showed significant effects on various clinical variables, as did investigated antibiotics. Notable differences in clinical and laboratory outcomes were observed, particularly in direct bilirubin levels, which were significantly higher in non-survivors. ROC analysis demonstrated high sensitivity and specificity of direct bilirubin as a predictor of mortality. These findings highlight the importance of targeted treatment strategies and the potential of specific laboratory markers in improving leptospirosis management.