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predisposition, insult, response and organ dysfunction.
A severity assessment score based on the PIRO (Predisposition, Insult, Response, and Organ dysfunction) concept was assessed, including comorbidities, age greater than 70 years, multilobar opacities in chest x-ray, shock, severe hypoxemia, acute renal failure, bacteremia, and acute respiratory distress syndrome.
This concept has been schematized in the recently proposed PIRO model (Predisposition, Insult, Response, and Organ dysfunction) [ 16].
He proposed an IRO (Insult, Response, Organ dysfunction) staging system that might be helpful in this regard, just as TNM (Tumor, Nodes, Metastasis) staging is in oncology trials.
Factors predicting mortality in severe leptospirosis as reported in various studies worldwide have been reviewed by Rajapakse et al. [ 6] under the categories of predisposition, insult, response and organ dysfunction (similar to the PIRO model used to predict mortality in severe sepsis).
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