Coura-Vital Wendel, Araújo Valdelaine Etelvina Miranda de, Reis Ilka Afonso, Amancio Frederico Figueiredo, Reis Alexandre Barbosa, Carneiro Mariângela
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.
Secretaria Municipal de Saúde, Prefeitura de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil; Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
PLoS Negl Trop Dis. 2014 Dec 11;8(12):e3374. doi: 10.1371/journal.pntd.0003374. eCollection 2014 Dec.
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.
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.
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.
在巴西，内脏利什曼病（VL）的病死率很高，了解与死亡相关的危险因素可能有助于降低死亡率。本研究的目的是通过分析2007年至2011年巴西报告的所有VL病例，构建并验证一个VL死亡预后评分系统。
在这项历史性队列研究中，分析了18501例VL病例；其中，17345例治愈，1156例死亡。数据库分为两个系列：主要系列（病例的三分之二）用于建立模型评分，次要系列（病例的三分之一）用于验证评分系统。采用多变量逻辑回归模型确定与VL死亡相关的因素，并将这些因素纳入评分系统。
与VL死亡相关的因素有：出血（评分3）；脾肿大（评分1）；水肿（评分1）；虚弱（评分1）；黄疸（评分1）；利什曼原虫与HIV合并感染（评分1）；细菌感染（评分1）；以及年龄（≤0.5岁[评分5]；>0.5岁且≤1岁[评分2]；>19岁且≤50岁[评分2]；>50岁且<65岁[评分3]；≥65岁[评分5]）。观察到评分4的患者死亡概率约为4.5%，预后较差。该评分的敏感性、特异性和准确性分别为89.4、51.2和53.5。
结论/意义：基于死亡危险因素的评分系统在临床怀疑VL时识别有严重体征的患者方面表现良好，有助于改进监测系统以降低病死率。根据患者的死亡预后进行分类，可能有助于就将患者转至更有能力处理其病情的医院、入住重症监护病房以及给予适当支持和特定治疗等决策提供帮助。
