The Characteristics of Patients That Develop Severe Leptospirosis: A Scoping Review

This scoping review of original literature published before 1 March 2025 examined the demographic and simple clinical and laboratory findings associated with the development of severe leptospirosis. The definition of severe leptospirosis varied in different studies, but for the purposes of this review it included death or patients with a more complicated clinical course. There were 35 articles that satisfied the review’s inclusion criteria. Increasing age was associated with severe disease in 7 studies. Abnormal respiratory examination findings (18 studies), hypotension (11 studies), oliguria (8 studies), jaundice (7 studies) and altered mental status (4 studies) also helped identify high-risk patients. Abnormal laboratory tests—specifically the complete blood count (17 studies), measures of renal function (16 studies) and liver function (14 studies)—were also associated with severe disease. There was geographical heterogeneity in the clinical phenotype of severe disease, but the presence of hypotension, respiratory or renal involvement had prognostic utility in all regions. Simple bedside findings and basic laboratory tests can provide valuable clinical information in patients with leptospirosis. Integration of these indices into early risk stratification tools may facilitate recognition of the high-risk patient and expedite escalation of care in resource-limited settings where most cases of life-threatening leptospirosis are seen.