Dias Tourinho Bruna, Figueiredo Amâncio Frederico, Lencine Ferraz Marcela, Carneiro Mariângela
Programa de Pós Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130 Belo Horizonte, Brazil.
Diretoria de Vigilância Ambiental, Superintendência de Vigilância Epidemiológica, Ambiental e Saúde do Trabalhador, Subsecretaria de Vigilância em Saúde, Secretaria de Estado de Saúde de Minas Gerais, 30130 Belo Horizonte, Minas Gerais, Brazil.
Trans R Soc Trop Med Hyg. 2017 Apr 1;111(4):163-171. doi: 10.1093/trstmh/trx029.
To characterize the clinical and epidemiological profiles of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (LAmB) and to identify prognostic factors for death from VL in 2008-2012 in the state of Minas Gerais, Brazil.
A historical cohort study was conducted using data obtained from treatment requests forms, Brazilian Notifiable Disease Information System and the Mortality Information System. Case-fatality rates of patients with VL treated with LAmB were compared with patients treated with other therapies. Logistic regression analysis was used to identify prognostic factors for death.
The overall case-fatality rate of the 577 patients treated with LAmB was 19.4%. Prognostic factors for death from VL were age between 35 and 49 years (OR 2.7; 95% CI 1.3-5.4) and above 50 years (OR 2.6; 95% CI 1.3-4.9), jaundice (OR 2.2; 95% CI 1.2-3.7), kidney disease (OR 2.8; 95% CI 1.6-4.9), presence of other infections (OR 2.4; 95% CI 1.5-4.1), edema (OR 2.0; 95% CI 1.1-3.4), platelet count below 50.000/mm3 (OR 3.6; 95% CI 2.1-6.0), AST higher than 100 U/L (OR 2.2; 95% CI 1.3-3.8), and assistance in non-specialized institutions (OR 1.9; 95% CI 1.0-3.5).
Case-fatality rates were higher than that observed among patients with VL treated with other therapies. Identification of prognostic factors of death from VL may allow early diagnosis of patients prone to such outcome and prompt an expeditious and appropriate management of VL to reduce fatality rates.
描述接受脂质体两性霉素B(LAmB)治疗的内脏利什曼病(VL)患者的临床和流行病学特征,并确定2008 - 2012年巴西米纳斯吉拉斯州VL患者死亡的预后因素。
采用从治疗申请表、巴西法定传染病信息系统和死亡率信息系统获得的数据进行历史性队列研究。将接受LAmB治疗的VL患者的病死率与接受其他疗法治疗的患者进行比较。采用逻辑回归分析确定死亡的预后因素。
577例接受LAmB治疗的患者的总体病死率为19.4%。VL患者死亡的预后因素为年龄在35至49岁之间(比值比[OR] 2.7;95%置信区间[CI] 1.3 - 5.4)和50岁以上(OR 2.6;95% CI 1.3 - 4.9)、黄疸(OR 2.2;95% CI 1.2 - 3.7)、肾脏疾病(OR 2.8;95% CI 1.6 - 4.9)、存在其他感染(OR 2.4;95% CI 1.5 - 4.1)、水肿(OR 2.0;95% CI 1.1 - 3.4)、血小板计数低于50,000/mm³(OR 3.6;95% CI 2.1 - 6.0)、天门冬氨酸氨基转移酶(AST)高于100 U/L(OR 2.2;95% CI 1.3 - 3.8)以及在非专科医院接受治疗(OR 1.9;95% CI 1.0 - 3.5)。
病死率高于接受其他疗法治疗的VL患者。确定VL患者死亡的预后因素可使易于出现这种结局的患者得到早期诊断,并促使对VL进行迅速且适当的管理以降低病死率。