Risk factors for death in children with visceral leishmaniasis
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 factor...
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| Veröffentlicht in: | PLoS neglected tropical diseases 2010-11, Vol.4 (11), p.e877-e877 |
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| description | 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.
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 |
| doi_str_mv | 10.1371/journal.pntd.0000877 |
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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%).
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.</description><identifier>ISSN: 1935-2735</identifier><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0000877</identifier><identifier>PMID: 21072238</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Antibiotics ; Bacterial diseases ; Bacterial infections ; Blood products ; Brazil - epidemiology ; Child ; Child, Preschool ; Epidemiology ; Ethics ; Fatalities ; Female ; Hospitals ; Humans ; Infant ; Infections ; Infectious Diseases/Neglected Tropical Diseases ; Infectious Diseases/Protozoal Infections ; Leishmania ; Leishmaniasis, Visceral - epidemiology ; Leishmaniasis, Visceral - mortality ; Male ; Medical prognosis ; Mortality ; Observational studies ; Parasitic diseases ; Pediatrics and Child Health ; Public health ; Public Health and Epidemiology/Infectious Diseases ; Retrospective Studies ; Risk Factors ; Sociodemographics ; Tropical diseases ; Vector-borne diseases</subject><ispartof>PLoS neglected tropical diseases, 2010-11, Vol.4 (11), p.e877-e877</ispartof><rights>2010 Sampaio et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Sampaio MJAdQ, Cavalcanti NV, Alves JGB, Fernandes Filho MJC, Correia JB (2010) Risk Factors for Death in Children with Visceral Leishmaniasis. PLoS Negl Trop Dis 4(11): e877. doi:10.1371/journal.pntd.0000877</rights><rights>Sampaio et al. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c590t-ca4d0703f98ec830356762b6f5bd160c37987659a09225f2af1c9e36183128393</citedby><cites>FETCH-LOGICAL-c590t-ca4d0703f98ec830356762b6f5bd160c37987659a09225f2af1c9e36183128393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970542/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970542/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21072238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sampaio, Márcia Jaqueline Alves de Queiroz</creatorcontrib><creatorcontrib>Cavalcanti, Nara Vasconcelos</creatorcontrib><creatorcontrib>Alves, João Guilherme Bezerra</creatorcontrib><creatorcontrib>Filho, Mário Jorge Costa Fernandes</creatorcontrib><creatorcontrib>Correia, Jailson B</creatorcontrib><title>Risk factors for death in children with visceral leishmaniasis</title><title>PLoS neglected tropical diseases</title><addtitle>PLoS Negl Trop Dis</addtitle><description>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.
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%).
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. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sampaio, Márcia Jaqueline Alves de Queiroz</au><au>Cavalcanti, Nara Vasconcelos</au><au>Alves, João Guilherme Bezerra</au><au>Filho, Mário Jorge Costa Fernandes</au><au>Correia, Jailson B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for death in children with visceral leishmaniasis</atitle><jtitle>PLoS neglected tropical diseases</jtitle><addtitle>PLoS Negl Trop Dis</addtitle><date>2010-11-02</date><risdate>2010</risdate><volume>4</volume><issue>11</issue><spage>e877</spage><epage>e877</epage><pages>e877-e877</pages><issn>1935-2735</issn><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>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.
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%).
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>21072238</pmid><doi>10.1371/journal.pntd.0000877</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Antibiotics Bacterial diseases Bacterial infections Blood products Brazil - epidemiology Child Child, Preschool Epidemiology Ethics Fatalities Female Hospitals Humans Infant Infections Infectious Diseases/Neglected Tropical Diseases Infectious Diseases/Protozoal Infections Leishmania Leishmaniasis, Visceral - epidemiology Leishmaniasis, Visceral - mortality Male Medical prognosis Mortality Observational studies Parasitic diseases Pediatrics and Child Health Public health Public Health and Epidemiology/Infectious Diseases Retrospective Studies Risk Factors Sociodemographics Tropical diseases Vector-borne diseases |
| title | Risk factors for death in children with visceral leishmaniasis |
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