Endothelial biomarkers as predictors for haemodialysis need in severe leptospirosis patients (Weil's disease)

Abstract

Objective: To investigate the prediction ability of vascular injury biomarkers for haemodialysis requirement in patients with severe leptospirosis. Methods: Prospective study with severe leptospirosis patients hospitalised in Fortaleza, Brazil. Blood samples were collected hospital admission to quantify vascular injury biomarkers: syndecan-1, ICAM-1, VCAM-1, angiopoietin-2 and FGF-23. Two groups were evaluated according to haemodialysis requirement during hospital stay. Results: Twenty-seven patients were included, with a mean age of 39 AE 18 years. 88.9% were males. 53.8% needed haemodialysis and presented higher levels on hospital admission of syndecan-1 (572 [300-811] vs. 263 [106-421] ng/ml; p = 0.03), angiopoietin-2 (1.52 [0.72-2.72] vs. 0.63 [0.4-1.38] ng/ml; p = 0.01), and FGF-23 (291 [56-2031] vs. 10 [10-806] pg/ml; p = 0.021). Syndecan-1 showed significant correlation with creatinine (r = 0.546; p = 0.05) and total bilirubin levels (r = 0.534; p = 0.013) on hospital admission. Angiopoietin-2 showed significant correlation with creatinine levels (r = 0.513; p = 0.009) on hospital admission and with number of haemodialysis sessions (r = 0.406; p = 0.049). No significant correlation was found with FGF-23. Regarding prognostic performance, combined syndecan-1 and angiopoietin-2 levels had a better ability to predict haemodialysis need in patients with severe leptospirosis (AUC-ROC = 0.744 [95% CI: 0.545-0.943] p = 0.035). Conclusion: Syndecan-1 and angiopoietin-2 were associated with haemodialysis need in patients with severe leptospirosis and may be useful to improve therapeutic approach and reduce mortality.

Acute Kidney Injury Associated with Severe Leptospirosis: Fatal Re-Emerging Disease in Latin America

“…Currently, the search for biomarkers to predict the need for RRT in patients with severe leptospirosis has been of interest in the region. Meneses et al [11], in a prospective study carried out in Brazil, reported that patients with RRT presented significantly higher levels of Syndecan-1, angiopoietin-2, and FGF-23 compared to those without RRT. However, scientific progress is awaited to obtain more information on the use of these biomarkers in patients with severe leptospirosis.…”

“…in the kidney involves the increased expression of proinflammatory molecules such as neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemotactic protein 1 (MCP-1) [66], kidney injury molecule 1 (KIM-1), and N-acetyl-D-glucosaminidase (NAG) [67]. Although these biomarkers are not specific for AKI and leptospirosis, their measurement has been important in the early detection of AKI to reduce associated complications in patients with leptospirosis [11].…”

“…Of the 18 published articles, 5 were published before 2010 (27.8%) [16,62,[103][104][105], 11 between 2011 and 2020 (61.1%) [17,28,64,65,102,[106][107][108][109][110][111], and 2 studies were published after 2021 [11,76]. In total, 72.2% (N = 13/18) of the articles included information from Brazil, 16.7% (N = 3/18) from Colombia, and 16.7% from Central America (N = 2/18) (see Table 1).…”

“…Of the articles reviewed, the need for RRT was 34.9% (N = 1187/3402) in patients with severe leptospirosis in Latin America [16,17,28,62,64,65,76,[102][103][104][105][106][107][108][109][110][111]. Brazil was the country with the greatest scientific evidence, finding a prevalence of 40% (N = 1114/2785) [11,16,17,28,62,64,65,103,104,106,108,110,111], followed by Colombia with 15.6% (N = 52/334) [76,102,107].…”

“…The presence of AKI is an early manifestation of severe leptospirosis and its incidence ranges from 10 to 60% of total cases [1]. This can occur due to the direct action of the etiological agent, dehydration, rhabdomyolysis, and hemodynamic alterations [11]. Leptospira spp.…”