Background: Leptospirosis can present with varied clinical manifestations ranging from mild self-limiting illness to severe disease with multi-organ involvement. There is limited data on the hepatic dysfunction in leptospirosis, especially in patients with underlying cirrhosis.This study aimed to analyse the hepatic dysfunction due to leptospirosis in both cirrhotic and non-cirrhotic patients, and subsequently identify predictors of mortality. 

Methods: Medical records of serologically confirmed cases of leptospirosis admitted to a tertiary care centre over one year period were analysed retrospectively. Clinical features including hepatic dysfunction in patients with and without underlying cirrhosis were compared. Multivariate regression analysis was performed to find predictors of mortality.

Results: 257 patients of leptospirosis were screened. After exclusion, 204 patients (mean age- 45.2 ±11.4 years; male:female=4.1:1) were enrolled, of whom 46.6% (n=95) had underlying cirrhosis. The 2 groups i.e. cirrhotics (n=95) and non-cirrhotics (n=109) were compared. Proportion of patients with hepatic involvement (91.6% vs 61.5%;p=0.0001), hepato-renal involvement (58.9% vs. 43.8%;p=0.024) and neurological involvement (54.7% vs 24.8%;p=0.0001) were significantly higher in cirrhotic group, while those with pulmonary or renal involvement were similar in both groups. Mean bilirubin was significantly higher, while transaminases, albumin, platelet counts and fever at presentation (74.7% vs 94.4%) were significantly lower in cirrhotic group. Cirrhotics had significantly higher mortality compared to non-cirrhotics (29.5% vs 20.2%;p=0.047). On multivariate analysis, hepato-renal involvement, presence of cirrhosis and need for artificial ventilation correlated with mortality.

Conclusion: Hepatic dysfunction in patients with leptospirosis was common, and a significant proportion of these patients had underlying cirrhosis. Compared to non-cirrhotics, cirrhotics were more likely to have afebrile presentation, higher chances of hepato-renal and neurological involvement, and higher mortality.