BACKGROUND Leptospirosis is an important zoonotic disease within the tropics. Diagnosing leptospirosis is a clinical obstacle, as clinical presentations are similar to other tropical infectious diseases. Available serological tests are often insensitive and not cost-effective. Many clinical diagnostic scorings had been developed but most were based on hospitalized patients, and wound not be suitable for use in suspected patients in setting of ambulatory care. OBJECTIVES To develop and internal validate multivariable diagnostic prediction score of leptospirosis in patients suspicious of leptospirosis at out-patient clinics of community hospitals. MATERIALS AND METHODS We performed a prospective, multisite diagnostic prediction research with development of a diagnostic score. The development cohort was based on patients suspicious of leptospirosis who visited five community hospitals in Si Sa Ket province, Thailand during December 2017 to November 2018. Leptospirosis confirmed cases were defined when one of the three standard confirmatory tests was positive. Multivariable logistic regression was used for score derivation. Test of AuROC equality was done to compare diagnostic performance of the newly derived score and conventional WHO score. RESULTS A total of 262 leptospirosis suspicious patients were enrolled. Eighty-two patients (31.5%) were leptospirosis confirmed cases. Five final predictors remained within the reduced logistic model which were history of exposure to wet ground at workplace, history of contact water reservoir used by animal, urine protein and urine blood positive from dipstick test, and neutrophil count from CBC ≥80%. The OPD score diagnostic performance was AuROC 0.72 (95%CI 0.65-0.79). Test of equality revealed significant differences of AuROC between the OPD and WHO score (0.72 vs 0.62, p-value 0.014). Patients were categorized into low and high probability of having leptospirosis at score point of 3.5 with sensitivity 72.4% and specificity 61.7%. CONCLUSIONS This study developed and internal validated the OPD score. This clinical risk score could be one of the important tools for diagnosis of leptospirosis at the outpatient clinic.

中文翻译：

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在门诊部诊断和诊断钩端螺旋体病简单评分的开发和验证。

背景技术钩端螺旋体病是热带地区的一种重要的人畜共患病。诊断钩端螺旋体病是一种临床障碍，因为临床表现与其他热带传染病相似。可用的血清学检测通常不敏感且不符合成本效益。已经开发了许多临床诊断评分，但大多数基于住院患者，并且伤口不适合在可疑患者中进行门诊护理。目的在社区医院的门诊中建立并内部验证可疑钩端螺旋体病患者的钩端螺旋体病多变量诊断预测评分。材料和方法随着诊断评分的提高，我们进行了一项前瞻性，多站点的诊断预测研究。该开发队列基于2017年12月至2018年11月在泰国Si Sa Ket省的五家社区医院就诊的可疑钩端螺旋体病的患者。当三种标准验证性试验之一为阳性时，就确定为钩端螺旋体病确诊病例。多变量logistic回归用于评分推导。进行AuROC相等性测试以比较新得出的评分和常规WHO评分的诊断性能。结果总共招募了262名钩端螺旋体病可疑患者。钩端螺旋体病确诊病例82例（31.5％）。在简化的逻辑模型中，还有五个最终预测指标，分别是工作场所接触过湿地的历史，动物使用的接触水库的历史，量油尺测试呈阳性的尿蛋白和尿血，CBC≥80％的中性粒细胞计数。OPD评分诊断性能为AuROC 0.72（95％CI 0.65-0.79）。平等性检验显示OPD和WHO评分之间的AuROC有显着差异（0.72比0.62，p值0.014）。将患者分类为钩端螺旋体病的低和高概率在3.5分，敏感性为72.4％，特异性为61.7％。结论本研究开发并内部验证了OPD评分。该临床风险评分可能是门诊诊断钩端螺旋体病的重要工具之一。将患者分类为钩端螺旋体病的低和高概率在3.5分，敏感性为72.4％，特异性为61.7％。结论本研究开发并内部验证了OPD评分。该临床风险评分可能是门诊诊断钩端螺旋体病的重要工具之一。将患者分类为钩端螺旋体病的低和高概率在3.5分，敏感性为72.4％，特异性为61.7％。结论本研究开发并内部验证了OPD评分。该临床风险评分可能是门诊诊断钩端螺旋体病的重要工具之一。