The concept on the use of glucocorticosteroids in the therapy of severe leptospirosis

Objective. To create a concept on the use of glucocorticosteroids (GCS) in severe leptospirosis: to compare the efficiency of different GCS therapy regimens and to determine their safety, as well as to assess whether it is appropriate to use GCS in severe leptospirosis as a whole. Subjects and methods. GCSs were used in the therapy of 231 patients with severe leptospirosis: Group 1 included 45 patients who received GCS pulse therapy; Group 2 consisted of 186 patients who had a medium-dose GCS regimen. A comparison group comprised 53 patients who did not take GCSs. The investigators determined the severity of multiple organ dysfunction (MOD) on the sequential organ failure assessment (SOFA) scale; as well as platelet counts in peripheral blood, fibrinogen level, activated partial thromboplastin time, prothrombin index, platelet aggregation area, von Willebrand factor ristomycin cofactor activity, minimum amplitude and lifetime for the presence of a clot, as evidenced by an electrocoagulogram, the levels of soluble fibrin-monomer complexes, plasma free hemoglobin, and the activity of glucose-6-phosphate dehydrogenase. Survival analysis was carried out using the Kaplan-Meier method with the Cox proportional hazards model. The risk ratio (RR [CI]) and odds ratio (OR [CI]) were calculated at a 95% confidence interval. Results. In patients with leptospirosis and a SOFA MOD of > 16scores, GCSs contribute to a reduction in the severity of MOD and can be used in the medium-dose GCS regimen or as pulse therapy. There is no evidence for the benefits of the impact of any GCS therapy regimen on patient survival. The indication for GCS therapy for severe leptospirosis is not only septic shock with adrenal insufficiency, but also other organ dysfunction. The use of GCS pulse doses should be strictly limited when there is a set of the following factors: consumption coagulopathy, Stage III acute kidney injury damage according to the Acute Kidney Injury Network (AKIN), and renal replacement therapy. Conclusion. The proposed concept on the use of GCS will be able to optimize therapy for severe leptospirosis.

leptospirosis, glucocorticosteroids, survival, pulse therapy