Risk Factors for Adverse Prognosis and Death in American Visceral Leishmaniasis: A Meta-analysis
Risk Factors for Adverse Prognosis and Death in American Visceral Leishmaniasis: A Meta-analysis
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DOI：
10.1371/journal.pntd.0002982
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发表时间：
2014-07-01
影响因子：
3.8
通讯作者：
Werneck, Guilherme Loureiro
中科院分区：
文献类型：
--
作者：
Belo, Vinicius Silva;Struchiner, Claudio Jose;Werneck, Guilherme Loureiro
背景：在当前与美国内脏利什曼病（VL）相关的高死亡率的背景下，适当使用预后因素来识别不良结果风险较高的患者是临床实践的潜在工具。本系统综述汇集了在拉丁美洲进行的研究报告的信息，这些信息涉及不良预后（尽管实施了治疗，患者初始临床状况持续演变，与死亡的发生无关）和 VL 死亡的潜在预测因素。介绍了现有知识的局限性、取得的进展以及未来研究中使用的方法。 方法/主要发现：对符合纳入标准的 14 项研究的全文进行了分析，并通过根据当前研究工具开发的工具检查了其方法学质量。使用荟萃分析综合有关预后变量的信息。根据证据强度对变量进行分组，考虑到总结措施、效应大小的模式和异质性以及多变量分析的结果。本次综述中确定的最强预测因素是黄疸、血小板减少症、出血、HIV 合并感染、腹泻、年龄 40-50 岁、严重中性粒细胞减少症、呼吸困难和细菌感染。水肿和低血红蛋白浓度也与不良结果相关。所发现的主要局限性是迄今为止开发的少数预后模型缺乏验证程序。结论/意义：整合过去 10 年进行的不同研究的结果能够识别一致的预后变量，这些变量可用于识别和处理具有较高不良结果风险的 VL 患者。在未来的研究中必须优先考虑开发外部验证的预后模型。
Background: In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.Methods/Principal Findings: The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age 40-50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.Conclusions/Significance: Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.