Simple clinical decision model for predicting leptospirosis: a secondary analysis of a randomized controlled trial
Abstract
BACKGROUND: Leptospirosis is a major cause of febrile illness in tropical regions, but early diagnosis is challenging due to overlapping clinical features and delayed serological confirmation. We developed a simple bedside decision model using readily available clinical variables.
METHODS: This secondary analysis used archived data from a randomized controlled trial of adults with undifferentiated febrile illness (October 2020-February 2021) of 5-15 days' duration. Independent predictors of IgM-ELISA positive leptospirosis were identified using multivariable logistic regression. A simplified score assigning one point per predictor was derived. Discrimination was assessed using ROC analysis, and post-test probabilities were modelled for clinical combinations and simulated rapid diagnostic testing.
RESULTS: Among 190 patients, 48 (25.3%) were serologically positive for leptospirosis. Conjunctival suffusion, icterus and acute kidney injury were independent predictors. The score (0-3) showed good discrimination (AUC 0.801), with sensitivity 68.8% and specificity 82.4% at ≥2. An exploratory proteinuria-based model demonstrated moderate discrimination (AUC 0.741). Probability increased from 25% at baseline to 91% when all three predictors were present and to 97%-99% when combined with a positive rapid test.
CONCLUSIONS: A simple bedside score substantially increases the probability of diagnosing leptospirosis in patients with undifferentiated febrile illness of 5-15 days'…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 190 participants or records.
Read the paper
Related studies
- Combining in silico and in vitro approaches to identification of potent inhibitor against phospholipase A2 (PLA2)
- In silico and in vitro studies: investigating the chemical composition, DFT, molecular docking, and dynamic simulation of Satureja candidissima (Munby) Briq essential oil as a potential antibacterial agent
- Quercetin combined with ciprofloxacin and gentamicin inhibits biofilm formation and virulence in Staphylococcus aureus
- In silico study of the mechanism of action, pharmacokinetic and toxicological properties of some N-methylanthranilates and their analogs
- Anticonvulsant Effects of Citronellal, Daidzin, and Phytol, Possibly Through GABAA Receptor and Voltage-Gated Sodium Channel Interaction Pathways: In Vivo and In Silico Studies
- 2-Phenylcyclopropylmethylamine (PCPMA) Derivatives as D3R-Selective Ligands for 3D-QSAR, Docking and Molecular Dynamics Simulation Studies
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.