Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil.
PLoS Negl Trop Dis. 2010 Nov 2;4(11):e877. doi: 10.1371/journal.pntd.0000877.
Despite the major public health importance of visceral leishmaniasis (VL) in Latin America, well-designed studies to inform diagnosis, treatment and control interventions are scarce. Few observational studies address prognostic assessment in patients with VL. This study aimed to identify risk factors for death in children aged less than 15 years admitted for VL treatment in a referral center in northeast Brazil.
METHODOLOGY/PRINCIPAL FINDINGS: In a retrospective cohort, we reviewed 546 records of patients younger than 15 years admitted with the diagnosis of VL at the Instituto de Medicina Integral Professor Fernando Figueira between May 1996 and June 2006. Age ranged from 4 months to 13.7 years, and 275 (50%) were male. There were 57 deaths, with a case-fatality rate of 10%. In multivariate logistic regression, the independent predictors of risk of dying from VL were (adjusted OR, 95% CI): mucosal bleeding (4.1, 1.3-13.4), jaundice (4.4, 1.7-11.2), dyspnea (2.8, 1.2-6.1), suspected or confirmed bacterial infections (2.7, 1.2-6.1), neutrophil count <500/mm³ (3.1, 1.4-6.9) and platelet count <50,000/mm³ (11.7, 5.4-25.1). A prognostic score was proposed and had satisfactory sensitivity (88.7%) and specificity (78.5%).
CONCLUSIONS/SIGNIFICANCE: Prognostic and severity markers can be useful to inform clinical decisions such as whether a child with VL can be safely treated in the local healthcare facility or would potentially benefit from transfer to referral centers where advanced life support facilities are available. High risk patients may benefit from interventions such as early use of extended-spectrum antibiotics or transfusion of blood products. These baseline risk-based supportive interventions should be assessed in clinical trials.
尽管内脏利什曼病（VL）在拉丁美洲具有重要的公共卫生意义，但针对诊断、治疗和控制干预措施的精心设计的研究却很少。很少有观察性研究涉及 VL 患者的预后评估。本研究旨在确定在巴西东北部一家转诊中心接受 VL 治疗的 15 岁以下儿童死亡的危险因素。
方法/主要发现：在一项回顾性队列研究中，我们回顾了 1996 年 5 月至 2006 年 6 月期间在 Fernando Figueira 综合医学研究所因 VL 住院的 546 名 15 岁以下患者的记录。年龄从 4 个月到 13.7 岁不等，其中 275 名（50%）为男性。有 57 例死亡，病死率为 10%。在多变量逻辑回归中，VL 死亡风险的独立预测因素为（调整后的比值比，95%置信区间）：黏膜出血（4.1，1.3-13.4）、黄疸（4.4，1.7-11.2）、呼吸困难（2.8，1.2-6.1）、疑似或确诊细菌感染（2.7，1.2-6.1）、中性粒细胞计数<500/mm³（3.1，1.4-6.9）和血小板计数<50,000/mm³（11.7，5.4-25.1）。提出了一种预后评分，具有良好的敏感性（88.7%）和特异性（78.5%）。
结论/意义：预后和严重程度标志物可用于为临床决策提供信息，例如，是否可以在当地医疗机构安全治疗患有 VL 的儿童，或者是否有可能从转移到可提供先进生命支持设施的转诊中心中受益。高危患者可能受益于早期使用广谱抗生素或输血等干预措施。这些基于风险的基线支持性干预措施应在临床试验中进行评估。
