Cardiovascular manifestations and outcomes in patients with leptospirosis admitted to a tertiary care center in the Coastal Karnataka region in India

Introduction: Leptospirosis is a globally prevalent zoonotic infection caused by Leptospira species. Cardiac involvement is increasingly recognized, yet large-scale studies comprehensively evaluating electrocardiographic and echocardiographic manifestations, including myocarditis, remain limited. Methods: This retrospective study included adult patients with clinically suspected leptospirosis and positive IgM ELISA admitted to a tertiary care hospital in South India between January 2016 and September 2020. Clinical features, electrocardiographic (ECG) findings, two-dimensional echocardiographic parameters, and in-hospital outcomes were analyzed. Binomial logistic regression was performed to identify independent predictors of all-cause mortality and myocarditis. Results: A total of 510 patients were analyzed (mean age 48.4 ± 13.7 years; 66.5% male). The mean hospital stay was 10.1 ± 6.1 days, with 40% requiring hospitalization beyond 10 days. Diabetes mellitus and hypertension were present in 16.7% and 16.9% of patients, respectively. Acute respiratory distress syndrome occurred in 10.6%, and 28% developed multiorgan dysfunction syndrome; 17.8% required hemodialysis. The most common ECG abnormalities were corrected QT interval prolongation (21.0%) and sinus tachycardia (20.8%). Echocardiographic evidence of myocarditis was observed in 10.4% of patients, including isolated left ventricular dysfunction (4.1%), isolated right ventricular dysfunction (3.9%), and biventricular dysfunction (2.4%). The overall in-hospital mortality rate was 8%. Increasing age, sinus tachycardia, QTc prolongation, hypertension, hemodialysis requirement, and myocarditis were independent predictors of mortality. Conclusions: Myocarditis represents a significant cardiac complication in leptospirosis and is associated with increased mortality. Routine cardiac evaluation may facilitate early detection and risk stratification. Clinical trial registration: Not applicable, as this study was retrospective in nature.