Background: The purpose of this retrospective case review was to identify the different patterns of clinical presentation of severe leptospirosis, and to find out any correlation between organ specific complications and outcome of the patients. Method: Leptospirosis patients who were admitted to the ICU of General Medicine Department of HIMS, Hassan during July 2021 – September 2021 were included. Organ specific involvement in 6 organs namely heart, lung, kidney, liver, vascular, brain and spinal cord was recorded. One score was given to each organ involvement. Score was recorded on admission and discharge. Outcome of the patients were recorded as either discharged or died. Result: Renal, hepatic, hematological involvement was found in all patients. One out of 13 patients died and 12 patients were discharged without any sequele. All patients except one had 3 organ involvements and one had involvement of 4 organs. All patients who had 3 organs involved were discharged without any sequel after an average admission period of 5 days. Conclusion: Outcome of severe leptospirosis was not determined by the involvement of renal, hepatic and hematological systems. 4 or more organ involvement was associated with increased mortality. Combination of respiratory system involvement with neurological involvement was associated with a bad outcome. Seeking critical care management at 3 organ involvement stage would improve the outcome of the patients.