Year-end Sale % OFF 
Abstract
BackgroundIn Ethiopia, case fatality rates among subgroups of visceral leishmaniasis (VL) patients are high. A clinical prognostic score for death in VL patients could contribute to optimal management and reduction of these case fatality rates. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia.Methodology/Principal findingsWe conducted a retrospective cohort study in north west Ethiopia. Predictors with an adjusted likelihood ratio ≥1.5 or ≤0.67 were retained to calculate the predictor score. The derivation cohort consisted of 1686 VL patients treated at an upgraded health center and the external validation cohort consisted of 404 VL patients treated in hospital. There were 99 deaths in the derivation cohort and 53 deaths in the external validation cohort. The predictors of death were: age >40 years (score +1); HIV seropositive (score +1); HIV seronegative (score -1); hemoglobin ≤6.5 g/dl (score +1); bleeding (score +1); jaundice (score +1); edema (score +1); ascites (score +2) and tuberculosis (score +1). The total predictor score per patient ranged from -1 to +5. A score of -1, indicated a low risk of death (1.0%), a score of 0 an intermediate risk of death (3.8%) and a score of +1 to +5, a high risk of death (10.4–85.7%). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval: 0.79–0.87) in derivation, and 0.78 (95% confidence interval: 0.72–0.83) in external validation.Conclusions/SignificanceThe overall performance of the score was good. The score can enable the early detection of VL cases at high risk of death, which can inform operational, clinical management guidelines, and VL program management. Implementation of focused strategies could contribute to optimal management and reduction of the case fatality rates.
Highlights
Visceral leishmaniasis (VL) or kala-azar is a protozoan infection caused by the Leishmania donovani species complex [1]
External validation of the score was conducted at the Leishmania Research and Treatment Center (LRTC) at the University of Gondar Hospital supported by the Drugs for Neglected Diseases Initiative (DNDi)
Between January 2011 and December 2012, 525 patients were diagnosed with visceral leishmaniasis (VL) and treated at the LRTC
Summary
Visceral leishmaniasis (VL) or kala-azar is a protozoan infection caused by the Leishmania donovani species complex [1]. VL typically occurs in remote areas, characterized by limited access to health care and shortage of health professionals [2] It is present in approximately 70 countries, with 200,000–400,000 new cases and 20,000–40,000 deaths occurring annually. In Ethiopia, more than 60% of VL transmission and burden occurs in the north western semi-arid lowlands In this VL focus, VL-HIV co-infection rate is 20–40%, the highest in the world and non-immune young male seasonal migrant workers from the highlands are the most at risk [4,6]. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
