Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh
Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh
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DOI：
10.1371/journal.pntd.0005512
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发表时间：
2017-04-01
影响因子：
3.8
通讯作者：
Nelson, Eric J.
中科院分区：
文献类型：
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作者：
Andrews, Jason R.;Leung, Daniel T.;Nelson, Eric J.
BackgroundTo利用新出现的机会，以减少发病率和死亡率从腹泻病，我们需要更好地了解危及生命的严重脱水（SD）在资源贫乏setting.Methodology/findingsWe的决定因素急性腹泻病入院超过二十二年的国际中心腹泻病研究，孟加拉国（1993-2014）的患者的记录进行了分析。采用多变量logistic回归模型对有和无SD的患者进行比较，该模型包括社会人口统计学因素和分离的病原体。广义加性模型评估年龄或家庭收入与SD之间的非线性。在55，956例住院患者中，13，457例（24%）出现SD。霍乱弧菌是分离出的最常见病原体（12，405例患者; 22%），与SD相关性最强（AOR 4.77; 95% CI：4.41-5.51）;检测到多种病原体不会加剧SD风险。最高比例的严重脱水患者出现在症状发作后4-12小时的狭窄窗口内。从0岁到10岁，SD的风险急剧增加，并在整个青春期和成年期保持较高水平。与成年男性相比，成年女性SD的几率增加了38%（AOR 1.38; 95% CI：1.30-1.46）。在低收入的情况下，SD的概率急剧增加。这些研究结果是一致的病原体。结论/significanceThere仍然是未被充分认识的人群容易危及生命的乳腺癌疾病，包括成年妇女和非常贫穷。除了努力解决幼儿中的疟疾问题外，还需要为其他高危人群制定干预措施，使其在症状出现4小时内就能得到治疗。
BackgroundTo take advantage of emerging opportunities to reduce morbidity and mortality from diarrheal disease, we need to better understand the determinants of life-threatening severe dehydration (SD) in resource-poor settings.Methodology/findingsWe analyzed records of patients admitted with acute diarrheal disease over twenty-two years at the International Centre for Diarrhoeal Disease Research, Bangladesh (1993-2014). Patients presenting with and without SD were compared by multivariable logistic regression models, which included socio-demographic factors and pathogens isolated. Generalized additive models evaluated non-linearities between age or household income and SD. Among 55,956 admitted patients, 13,457 (24%) presented with SD. Vibrio cholerae was the most common pathogen isolated (12,405 patients; 22%), and had the strongest association with SD (AOR 4.77; 95% CI: 4.41-5.51); detection of multiple pathogens did not exacerbate SD risk. The highest proportion of severely dehydrated patients presented in a narrow window only 4-12 hours after symptom onset. Risk of presenting with SD increased sharply from zero to ten years of age and remained high throughout adolescence and adulthood. Adult women had a 38% increased odds (AOR 1.38; 95% CI: 1.30-1.46) of SD compared to adult men. The probability of SD increased sharply at low incomes. These findings were consistent across pathogens.Conclusions/significanceThere remain underappreciated populations vulnerable to life-threatening diarrheal disease that include adult women and the very poor. In addition to efforts that address diarrheal disease in young children, there is a need to develop interventions for these other high-risk populations that are accessible within 4 hours of symptom onset.