Laboratório de Epidemiologia das Doenças Infecciosas e Parasitárias, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Laboratório de Epidemiologia e Bioestatística, Programa de Pós-graduação Stricto Sensu em Medicina e Biomedicina, Instituto de Ensino e Pesquisa Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil.
Trans R Soc Trop Med Hyg. 2020 May 7;114(5):346-354. doi: 10.1093/trstmh/traa010.
The aim of this study was to identify the prognostic factors associated with death from visceral leishmaniasis (VL) considering the clinical evolution of patients through a case-control study.
We randomly selected 180 cases (death caused by VL) and 180 controls (cured) from Belo Horizonte's hospitals in Brazil, according to data found in the patients' medical records. Five models of multivariate logistic regression were performed following the chronological order of the variables between the onset of the symptoms and evolution of the VL cases.
Considering the multivariate models and the stages of clinical evolution of VL, the prognostic factors associated with death are: age >60 y, minor hemorrhagic phenomena, increased abdominal volume, jaundice, dyspnea, malnutrition, TB, billirubin >2 mg/dL, Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT) >100 U/L, leukocytes >7000/mm3, hemoglobin <7 g/dL, platelets <50 000/mm3 and infection without defined focus and bleeding.
Knowledge regarding the prognostic factors associated with death from VL in different stages of the disease in large Brazilian urban centers such as Belo Horizonte may help optimize patient management strategies and contribute to reduce the high fatality rates in these cities.
本研究旨在通过病例对照研究，确定与内脏利什曼病（VL）死亡相关的预后因素，同时考虑患者的临床演变。
我们根据患者病历中的数据，从巴西贝洛奥里藏特的医院中随机选择了 180 例病例（由 VL 引起的死亡）和 180 例对照（治愈）。根据 VL 病例症状发作和演变的时间顺序，我们进行了五种多变量逻辑回归模型。
考虑到多变量模型和 VL 临床演变的各个阶段，与死亡相关的预后因素包括：年龄>60 岁、轻微出血现象、腹部体积增大、黄疸、呼吸困难、营养不良、结核病、胆红素>2mg/dL、天门冬氨酸氨基转移酶（AST）或丙氨酸氨基转移酶（ALT）>100U/L、白细胞计数>7000/mm3、血红蛋白<7g/dL、血小板计数<50000/mm3 以及无明确病灶和出血的感染。
了解贝洛奥里藏特等巴西大型城市中心不同疾病阶段与 VL 死亡相关的预后因素，可能有助于优化患者管理策略，并有助于降低这些城市的高死亡率。
