Prognostic factors and scoring system for death from visceral leishmaniasis: a historical cohort study in Brazil
In Brazil, case-fatality rates from visceral leishmaniasis (VL) are high and knowledge regarding the risk factors associate with death may contribute to lower mortality. The goals were to build and to validate a scoring system for prognosis of death from VL using cases reported in Brazil from 2007 to 2011.
METHODS: This historical cohort study analyzed 18,501 VL cases; of these 17,345 were cured and 1,156 died from VL. The database was provided by Brazilian Ministry of Health. The database was divided into two series: primary (2/3 of cases) to develop the prognostic score system; and secondary (1/3 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 prognostic scoring system.
RESULTS: The prognostic factors associated with death from VL were: bleeding (OR= 3.8; score 3), hepatomegaly (OR=1.5; score 1), edema (OR=1.8; score 1), weakness (OR= 1.7; score 1), jaundice (OR=1.6; score 1), Leishmania-HIV co-infection (OR=1.6; score 1), bacterial infection (OR=1.9; score 1) and age (≤ 0.5 years [OR=8.3; score 5]; >0.5 and ≤1 years [OR=2.8; score 2]; >19 and ≤50 (OR=2.4; score 2), >50 and <65 [OR=3.9; score 3]; ³65 [OR=9.5; score 5]). The scoring system performance showed an area of 0.77 (good performance) under the receiver operating characteristic curve. It was observed that patients with score of 11 have the probability of death of 26.9% and from this point, the prognosis worsens.
CONCLUSIONS:
Knowledge the factors associated with death can contribute to improve the surveillance system, the clinical management of the severe cases and to reduce the case-fatality rates from VL. Patients classified according to their prognosis may assist decision-making as their transfer to hospital care and admission to the intensive care unit.