Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity?
Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity?
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DOI：
10.1371/journal.pntd.0007841
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发表时间：
2019-12-01
影响因子：
3.8
通讯作者：
Sanchez-Vazquez, Manuel J.
中科院分区：
文献类型：
--
作者：
Maia-Elkhoury, Ana Nilce S.;Sierra Romero, Gustavo Adolfo;Sanchez-Vazquez, Manuel J.
内脏利什曼病（Visceral Leishmaniasis，VL）是利什曼病中最严重的一种，可导致死亡.在美洲，96%的病例发生在巴西，尽管做出了努力，但死亡率在过去几年中有所上升。我们分析了与巴西VL相关的死亡，并调查了可能影响致命结局及时性的因素，重点是时间（tStoD）。方法VL登记的死亡来自2007-2014年的巴西国家通知系统。通过回顾性队列研究，进行单变量和多变量考克斯比例风险模型分析，并调查可能影响时间（tStoD）的因素。这些因素进行了分析，通过生存models.ResultsOut的1，589报告的死亡，发病的症状和病例通知日期（tStoN）的中位数是25天（10-61），和病例通知和死亡的日期（tNotD）是9天（4-17）。HIV未感染者的至事件调查时间（tStoN）比HIV阳性组长1.4（1.16-1.68）。与此同时，城郊和城区分别为0.83（0.47-1.44）和1.33（1.16-1.52）。探索显示，至事件调查时间（tStoN和tNotD）与症状发作时的年龄之间存在明显差异。根据tStoN的通知率是1.73倍，在5岁以下的患者在发病时的临床症状相比，老年patients.ConclusionVL患者5岁以下的诊断较早，生存期较短。这可能意味着，在较年轻的人群中，尽管诊断正确，但死亡模式可能与疾病的严重程度有关。评价了主要宿主特征，年龄和合并感染似乎对疾病进展有影响。
BackgroundVisceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD).MethodologyThe registered deaths by VL were sourced from the Brazilian National Notification System from 2007-2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models.ResultsOut of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10-61), and for date of case notification and death (tNotD) is 9 days (4-17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16-1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47-1.44) and 1.33 (1.16-1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients.ConclusionVL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression.