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Prognostic factors and scoring system for death from visceral leishmaniasis: an historical cohort study in Brazil.

Coura-Vital W, Araújo VE, Reis IA, Amancio FF, Reis AB, Carneiro M - PLoS Negl Trop Dis (2014)

Bottom Line: Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system.The factors associated with death from VL were: bleeding (score 3); splenomegaly (score 1); edema (score 1); weakness (score 1); jaundice (score 1); Leishmania-HIV co-infection (score 1); bacterial infection (score 1); and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and <65 [score 3]; ≥65 [score 5]).The scoring system based on risk factors for death showed good performance in identifying patients with signs of severity at the time of clinical suspicion of VL and can contribute to improving the surveillance system for reducing case fatalities.

View Article: PubMed Central - PubMed

Affiliation: Pós-graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brasil.

ABSTRACT

Background: In Brazil, case-fatality rates attributable to visceral leishmaniasis (VL) are high and knowledge of the risk factors associated with death may help reduce mortality. The aim of this study was to construct and validate a scoring system for prognosis of death from VL by using all cases reported in Brazil from 2007 to 2011.

Methodology: In this historical cohort study, 18,501 VL cases were analyzed; of these, 17,345 cases were cured and 1,156 cases caused death. The database was divided into two series: primary (two-thirds of cases), to develop the model score, and secondary (one-third of cases), to validate the scoring system. Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system.

Principal findings: The factors associated with death from VL were: bleeding (score 3); splenomegaly (score 1); edema (score 1); weakness (score 1); jaundice (score 1); Leishmania-HIV co-infection (score 1); bacterial infection (score 1); and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and <65 [score 3]; ≥65 [score 5]). It was observed that patients with a score of 4 had a probability of death of approximately 4.5% and had a worse prognosis. The sensitivity, specificity, and accuracy of this score were 89.4, 51.2, and 53.5, respectively.

Conclusions/significance: The scoring system based on risk factors for death showed good performance in identifying patients with signs of severity at the time of clinical suspicion of VL and can contribute to improving the surveillance system for reducing case fatalities. The classification of patients according to their prognosis for death may assist decision-making regarding the transfer of the patients to hospitals more capable of handling their condition, admission to the intensive care unit, and adequate support and specific treatment.

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Flow diagram of the population evaluated.*Cases reported in Brazilian Reportable Disease Information System.
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pntd-0003374-g001: Flow diagram of the population evaluated.*Cases reported in Brazilian Reportable Disease Information System.

Mentions: A total of 41,934 suspected VL cases were registered in SINAN from 2007 to 2011; of these, 23,947 were confirmed. Among the patients with confirmed cases, 17,345 cases were cured (72.5%) and 1,156 (4.8%) patients died from VL, resulting in 18,501 individuals eligible for analysis. Among the ineligibles cases were 384 (1.6%) patients who died because of other causes, 138 (0.6%) patients who abandoned treatment, 1,348 (5.6%) patients who were moved to another region during the treatment (transference), and 3,576 (14.9%) patients without data regarding the evolution of the case (missing data). Furthermore, among the suspected cases, 14,608 (34.8%) were not included because infection by L. infantum was not confirmed and 3,379 (8.0%) had missing information regarding final classification (discarded or confirmed as VL) (Fig. 1).


Prognostic factors and scoring system for death from visceral leishmaniasis: an historical cohort study in Brazil.

Coura-Vital W, Araújo VE, Reis IA, Amancio FF, Reis AB, Carneiro M - PLoS Negl Trop Dis (2014)

Flow diagram of the population evaluated.*Cases reported in Brazilian Reportable Disease Information System.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263605&req=5

pntd-0003374-g001: Flow diagram of the population evaluated.*Cases reported in Brazilian Reportable Disease Information System.
Mentions: A total of 41,934 suspected VL cases were registered in SINAN from 2007 to 2011; of these, 23,947 were confirmed. Among the patients with confirmed cases, 17,345 cases were cured (72.5%) and 1,156 (4.8%) patients died from VL, resulting in 18,501 individuals eligible for analysis. Among the ineligibles cases were 384 (1.6%) patients who died because of other causes, 138 (0.6%) patients who abandoned treatment, 1,348 (5.6%) patients who were moved to another region during the treatment (transference), and 3,576 (14.9%) patients without data regarding the evolution of the case (missing data). Furthermore, among the suspected cases, 14,608 (34.8%) were not included because infection by L. infantum was not confirmed and 3,379 (8.0%) had missing information regarding final classification (discarded or confirmed as VL) (Fig. 1).

Bottom Line: Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system.The factors associated with death from VL were: bleeding (score 3); splenomegaly (score 1); edema (score 1); weakness (score 1); jaundice (score 1); Leishmania-HIV co-infection (score 1); bacterial infection (score 1); and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and <65 [score 3]; ≥65 [score 5]).The scoring system based on risk factors for death showed good performance in identifying patients with signs of severity at the time of clinical suspicion of VL and can contribute to improving the surveillance system for reducing case fatalities.

View Article: PubMed Central - PubMed

Affiliation: Pós-graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Núcleo de Pesquisas em Ciências Biológicas, Instituto de Ciências Exatas e Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brasil.

ABSTRACT

Background: In Brazil, case-fatality rates attributable to visceral leishmaniasis (VL) are high and knowledge of the risk factors associated with death may help reduce mortality. The aim of this study was to construct and validate a scoring system for prognosis of death from VL by using all cases reported in Brazil from 2007 to 2011.

Methodology: In this historical cohort study, 18,501 VL cases were analyzed; of these, 17,345 cases were cured and 1,156 cases caused death. The database was divided into two series: primary (two-thirds of cases), to develop the model score, and secondary (one-third of cases), to validate the scoring system. Multivariate logistic regression models were performed to identify factors associated with death from VL, and these were included in the scoring system.

Principal findings: The factors associated with death from VL were: bleeding (score 3); splenomegaly (score 1); edema (score 1); weakness (score 1); jaundice (score 1); Leishmania-HIV co-infection (score 1); bacterial infection (score 1); and age (≤0.5 years [score 5]; >0.5 and ≤1 [score 2]; >19 and ≤50 [score 2]; >50 and <65 [score 3]; ≥65 [score 5]). It was observed that patients with a score of 4 had a probability of death of approximately 4.5% and had a worse prognosis. The sensitivity, specificity, and accuracy of this score were 89.4, 51.2, and 53.5, respectively.

Conclusions/significance: The scoring system based on risk factors for death showed good performance in identifying patients with signs of severity at the time of clinical suspicion of VL and can contribute to improving the surveillance system for reducing case fatalities. The classification of patients according to their prognosis for death may assist decision-making regarding the transfer of the patients to hospitals more capable of handling their condition, admission to the intensive care unit, and adequate support and specific treatment.

Show MeSH
Related in: MedlinePlus