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Abstract：
OBJECTIVE: Leptospirosis is a waterborne zoonotic disease prevalent in tropical regions, causing significant morbidity and mortality. It can involve any organ in its primary stage, and uveitis is its late complication. While advanced laboratory diagnosis is available only in tertiary care centers globally, a cost-effective bedside assessment of clinical signs and their scoring could offer a provisional diagnosis.
OBJECTIVE: To analyze the diagnostic potential of demographic and clinical signs in a large cohort of serologically confirmed leptospiral uveitis patients.
METHODS: In this retrospective study, demographic and clinical parameters of 876 seropositive leptospiral uveitis patients and 1042 nonleptospiral uveitis controls were studied. Multivariable logistic regression analysis with bootstrap confidence interval (CI) characterized the diagnostic predictors. The performance of the model was evaluated using the area under the receiver operating curve (AUROC).
RESULTS: Presence of nongranulomatous uveitis (odds ratio [OR] = 6.9), hypopyon (OR = 4.6), vitreous infiltration with membranous opacities (OR = 4.3), bilateral involvement (OR = 4), panuveitis (OR = 3.3), vasculitis (OR = 1.9), disc hyperemia (OR = 1.6), absence of retinochoroiditis (OR = 15), and absence of cystoid macular edema (OR = 8.9) emerged as predictive parameters. The AUROC value was 0.86 with 95% CI of 0.846-0.874. At a cut-off score of 40, the sensitivity and specificity were 79.5 and 78.4, respectively.
CONCLUSIONS: The study demonstrates that ocular signs can serve as diagnostic predictors for leptospiral uveitis, enabling primary care ophthalmologists to make bedside diagnosis. This can be further confirmed by laboratory methods available at tertiary care centers.
OBJECTIVE: To analyze the diagnostic potential of demographic and clinical signs in a large cohort of serologically confirmed leptospiral uveitis patients.
METHODS: In this retrospective study, demographic and clinical parameters of 876 seropositive leptospiral uveitis patients and 1042 nonleptospiral uveitis controls were studied. Multivariable logistic regression analysis with bootstrap confidence interval (CI) characterized the diagnostic predictors. The performance of the model was evaluated using the area under the receiver operating curve (AUROC).
RESULTS: Presence of nongranulomatous uveitis (odds ratio [OR] = 6.9), hypopyon (OR = 4.6), vitreous infiltration with membranous opacities (OR = 4.3), bilateral involvement (OR = 4), panuveitis (OR = 3.3), vasculitis (OR = 1.9), disc hyperemia (OR = 1.6), absence of retinochoroiditis (OR = 15), and absence of cystoid macular edema (OR = 8.9) emerged as predictive parameters. The AUROC value was 0.86 with 95% CI of 0.846-0.874. At a cut-off score of 40, the sensitivity and specificity were 79.5 and 78.4, respectively.
CONCLUSIONS: The study demonstrates that ocular signs can serve as diagnostic predictors for leptospiral uveitis, enabling primary care ophthalmologists to make bedside diagnosis. This can be further confirmed by laboratory methods available at tertiary care centers.
摘要：
目的：钩端螺旋体病是一种在热带地区普遍存在的水传播的人畜共患疾病，导致显著的发病率和死亡率。它可以涉及任何处于初级阶段的器官，葡萄膜炎是其晚期并发症.虽然高级实验室诊断仅在全球三级护理中心可用，对临床体征及其评分进行具有成本效益的床旁评估可以提供临时诊断.
目的：分析大量血清学证实的钩端螺旋体葡萄膜炎患者的人口统计学和临床体征的诊断潜力。
方法：在这项回顾性研究中，研究了876例血清阳性钩端螺旋体葡萄膜炎患者和1042例非钩端螺旋体葡萄膜炎对照的人口统计学和临床参数.具有Bootstrap置信区间（CI）的多变量逻辑回归分析表征了诊断预测因子。使用接收器工作曲线下面积(AUROC)评估模型的性能。
结果：存在非肉芽肿性葡萄膜炎（比值比[OR]=6.9），hypopyon(OR=4.6),玻璃体浸润，膜性混浊（OR=4.3），双侧受累(OR=4)，全葡萄膜炎（OR=3.3），血管炎（OR=1.9），椎间盘充血（OR=1.6），没有视网膜脉络膜炎（OR=15），并无黄斑囊样水肿(OR=8.9)作为预测参数。AUROC值为0.86,95%CI为0.846-0.874。截止分数为40时，敏感性和特异性分别为79.5和78.4。
结论：研究表明，眼部体征可以作为钩端螺旋体葡萄膜炎的诊断预测因子，使初级保健眼科医生能够进行床边诊断。这可以通过三级护理中心可用的实验室方法进一步证实。
目的：分析大量血清学证实的钩端螺旋体葡萄膜炎患者的人口统计学和临床体征的诊断潜力。
方法：在这项回顾性研究中，研究了876例血清阳性钩端螺旋体葡萄膜炎患者和1042例非钩端螺旋体葡萄膜炎对照的人口统计学和临床参数.具有Bootstrap置信区间（CI）的多变量逻辑回归分析表征了诊断预测因子。使用接收器工作曲线下面积(AUROC)评估模型的性能。
结果：存在非肉芽肿性葡萄膜炎（比值比[OR]=6.9），hypopyon(OR=4.6),玻璃体浸润，膜性混浊（OR=4.3），双侧受累(OR=4)，全葡萄膜炎（OR=3.3），血管炎（OR=1.9），椎间盘充血（OR=1.6），没有视网膜脉络膜炎（OR=15），并无黄斑囊样水肿(OR=8.9)作为预测参数。AUROC值为0.86,95%CI为0.846-0.874。截止分数为40时，敏感性和特异性分别为79.5和78.4。
结论：研究表明，眼部体征可以作为钩端螺旋体葡萄膜炎的诊断预测因子，使初级保健眼科医生能够进行床边诊断。这可以通过三级护理中心可用的实验室方法进一步证实。
