乌干达东部内脏利什曼病患者院内死亡的危险因素

Risk factors for in-hospital mortality of visceral leishmaniasis patients in eastern Uganda.

作者信息

Mueller Yolanda, Mbulamberi Dawson B, Odermatt Peter, Hoffmann Axel, Loutan Louis, Chappuis François

机构信息

Médecins Sans Frontières, Geneva, Switzerland.

出版信息

Trop Med Int Health. 2009 Aug;14(8):910-7. doi: 10.1111/j.1365-3156.2009.02305.x. Epub 2009 Jun 22.

DOI:10.1111/j.1365-3156.2009.02305.x

PMID:19552645

Abstract

OBJECTIVE

To identify risk factors for in-hospital mortality in patients treated for visceral leishmaniasis (VL) in Uganda.

METHODS

Retrospective analysis of VL patients' clinical data collected for project monitoring by Médecins Sans Frontières in Amudat, eastern Uganda.

RESULTS

Between 2000 and 2005, of 3483 clinically suspect patients, 53% were confirmed with primary VL. Sixty-two per cent were children <16 years of age with a male/female ratio of 2.2. The overall case-fatality rate during pentavalent antimonial (n = 1641) or conventional amphotericin B treatment (n = 217) was 3.7%. There was no difference in the case-fatality rate between treatment groups (P > 0.20). The main risk factors for in-hospital death identified by a multivariate analysis were age <6 years and >15 years, concomitant tuberculosis or hepatopathy, and drug-related adverse events. The case-fatality rate among patients >45 years of age was strikingly high (29.0%).

CONCLUSION

Subgroups of VL patients at higher risk of death during treatment with drugs currently available in Uganda were identified. Less toxic drugs should be evaluated and used in these patients.

摘要

目的

确定乌干达接受内脏利什曼病（VL）治疗患者的院内死亡风险因素。

方法

对无国界医生组织在乌干达东部阿穆达特为项目监测收集的VL患者临床数据进行回顾性分析。

结果

2000年至2005年间，3483例临床疑似患者中，53%被确诊为原发性VL。62%为16岁以下儿童，男女比例为2.2。五价锑剂治疗组（n = 1641）或传统两性霉素B治疗组（n = 217）的总体病死率为3.7%。治疗组之间的病死率无差异（P > 0.20）。多变量分析确定的院内死亡主要风险因素为年龄<6岁和>15岁、合并结核病或肝病以及药物相关不良事件。45岁以上患者的病死率极高（29.0%）。