Derivation and External Validation of a Clinical Prediction Model for Viral Diarrhea Etiology in Bangladesh.
Derivation and External Validation of a Clinical Prediction Model for Viral Diarrhea Etiology in Bangladesh.
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DOI：
10.1093/ofid/ofad295
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发表时间：
2023-07
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
--
作者：
在许多低收入和中等收入国家，抗生素通常被过度用于治疗腹泻病，部分原因是缺乏确定病毒性病例的诊断方法，在这种情况下，抗生素不起作用。本研究旨在建立临床预测模型，利用常规收集的人口统计学和临床变量，预测所有年龄段的病毒性腹泻风险。我们使用了来自孟加拉国10家医院的衍生数据集和来自icddr，b Dhaka医院的单独验证数据集。主要结果是由粪便定量聚合酶链反应确定的病毒病原学。拟合多变量logistic回归模型并进行外部验证；用受试者工作特征曲线下面积（AUC）量化鉴别，用标定图评估校准。纯病毒性腹泻在所有年龄组中都很常见（<1岁，41.4%；18-55岁，17.7%）。正演逐步模型的AUC为0.82（95%置信区间[CI]， 0.80 -）。84)，而年龄、腹痛和便血的简化模型的AUC为0.81 （95% CI, 0.78 - 0.82）。在外部验证中，模型表现良好，但不太稳健（AUC, 0.72 [95% CI, 0.70 - 0.74]）。由3个常规收集的变量组成的预测模型可以准确预测孟加拉国所有年龄段患者的纯病毒性腹泻，并可能有助于支持减少不适当抗生素使用的努力。由常规收集的变量组成的预测模型被证明可以准确预测孟加拉国所有年龄段患者的纯病毒性腹泻，并可能有助于支持减少不适当抗生素使用的努力。
Antibiotics are commonly overused for diarrheal illness in many low- and middle-income countries, partly due to a lack of diagnostics to identify viral cases, in which antibiotics are not beneficial. This study aimed to develop clinical prediction models to predict risk of viral-only diarrhea across all ages, using routinely collected demographic and clinical variables. We used a derivation dataset from 10 hospitals across Bangladesh and a separate validation dataset from the icddr,b Dhaka Hospital. The primary outcome was viral-only etiology determined by stool quantitative polymerase chain reaction. Multivariable logistic regression models were fit and externally validated; discrimination was quantified using area under the receiver operating characteristic curve (AUC) and calibration assessed using calibration plots. Viral-only diarrhea was common in all age groups (<1 year, 41.4%; 18–55 years, 17.7%). A forward stepwise model had AUC of 0.82 (95% confidence interval [CI], .80–.84) while a simplified model with age, abdominal pain, and bloody stool had AUC of 0.81 (95% CI, .78–.82). In external validation, the models performed adequately although less robustly (AUC, 0.72 [95% CI, .70–.74]). Prediction models consisting of 3 routinely collected variables can accurately predict viral-only diarrhea in patients of all ages in Bangladesh and may help support efforts to reduce inappropriate antibiotic use. Prediction models consisting of routinely collected variables were shown to accurately predict viral-only diarrhea in patients of all ages in Bangladesh and may help support efforts to reduce inappropriate antibiotic use.
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影响因子：
1.8
作者：
Kahsay, Atsebaha Gebrekidan;Muthupandian, Saravanan
通讯作者：
Muthupandian, Saravanan
在资源有限的环境中，儿童急性腹泻病因的临床预测因子。
影响因子：
3.8
作者：
Brintz BJ;Howard JI;Haaland B;Platts-Mills JA;Greene T;Levine AC;Nelson EJ;Pavia AT;Kotloff KL;Leung DT
通讯作者：
Leung DT
影响因子：
3.7
作者：
Ballard SB;Reaves EJ;Luna CG;Silva ME;Rocha C;Heitzinger K;Saito M;Apaza S;Espetia S;Blazes DL;Tilley DH;Guzmán Aguilar RC;Gilman RH;Bausch DG
通讯作者：
Bausch DG
影响因子：
3.7
作者：
Dey SK;Sharif N;Sarkar OS;Sarkar MK;Talukder AA;Phan T;Ushijima H
通讯作者：
Ushijima H
影响因子：
2.3
作者：
Le, Chap T.
通讯作者：
Le, Chap T.