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Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis.

Belo VS, Struchiner CJ, Barbosa DS, Nascimento BW, Horta MA, da Silva ES, Werneck GL - PLoS Negl Trop Dis (2014)

Bottom Line: Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses.Edema and low hemoglobin concentration were also associated with unfavorable outcomes.Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil; Departamento Básico-Área da Saúde-Campus Governador Valadares, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brasil.

ABSTRACT

Background: In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.

Methods/principal findings: The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40-50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.

Conclusions/significance: Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.

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Related in: MedlinePlus

Conditions for assessment of the quality of the selected papers determined according to the principles described in the literature [15], [16], [23]–[26].
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pntd-0002982-g002: Conditions for assessment of the quality of the selected papers determined according to the principles described in the literature [15], [16], [23]–[26].

Mentions: There is no universally accepted or standardized tool for the identification of limitations or potential risks of bias in the analysis and/or presentation of data in studies relating to prognostic factors. Thus, in order to analyze the quality of studies reviewed we opted to use five publications [15], [16], [23]–[25] describing principles and methods for the development of prognostic models. Additionally, the STROBE statement, the aim of which is to strengthen the reporting of observational studies in epidemiology, was used to complement these resources [26]. Based on these publications, a set of 17 conditions was established in order to evaluate the adequacy of the methodology employed and the clarity of presentation of the results described in the included studies (Fig. 2).


Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis.

Belo VS, Struchiner CJ, Barbosa DS, Nascimento BW, Horta MA, da Silva ES, Werneck GL - PLoS Negl Trop Dis (2014)

Conditions for assessment of the quality of the selected papers determined according to the principles described in the literature [15], [16], [23]–[26].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109848&req=5

pntd-0002982-g002: Conditions for assessment of the quality of the selected papers determined according to the principles described in the literature [15], [16], [23]–[26].
Mentions: There is no universally accepted or standardized tool for the identification of limitations or potential risks of bias in the analysis and/or presentation of data in studies relating to prognostic factors. Thus, in order to analyze the quality of studies reviewed we opted to use five publications [15], [16], [23]–[25] describing principles and methods for the development of prognostic models. Additionally, the STROBE statement, the aim of which is to strengthen the reporting of observational studies in epidemiology, was used to complement these resources [26]. Based on these publications, a set of 17 conditions was established in order to evaluate the adequacy of the methodology employed and the clarity of presentation of the results described in the included studies (Fig. 2).

Bottom Line: Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses.Edema and low hemoglobin concentration were also associated with unfavorable outcomes.Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil; Departamento Básico-Área da Saúde-Campus Governador Valadares, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brasil.

ABSTRACT

Background: In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.

Methods/principal findings: The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40-50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.

Conclusions/significance: Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.

Show MeSH
Related in: MedlinePlus