Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil
ABSTRACT Background: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infecti...
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Sociedade Brasileira de Medicina Tropical (SBMT)
2024-02-01
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| Series: | Revista da Sociedade Brasileira de Medicina Tropical |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822024000100401&tlng=en |
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| author | Igor Monteiro Lima Martins Alfredo Maurício Batista de Paula Antônio Prates Caldeira Lanuza Borges Oliveira Luciano Freitas Fernandes |
| author_facet | Igor Monteiro Lima Martins Alfredo Maurício Batista de Paula Antônio Prates Caldeira Lanuza Borges Oliveira Luciano Freitas Fernandes |
| author_sort | Igor Monteiro Lima Martins |
| collection | DOAJ |
| description | ABSTRACT Background: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. Methods: This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. Results: The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. Conclusions: Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission. |
| first_indexed | 2024-03-07T21:23:43Z |
| format | Article |
| id | doaj.art-374ca4bfcddd440281b14d6c0a9479f5 |
| institution | Directory Open Access Journal |
| issn | 1678-9849 |
| language | English |
| last_indexed | 2024-03-07T21:23:43Z |
| publishDate | 2024-02-01 |
| publisher | Sociedade Brasileira de Medicina Tropical (SBMT) |
| record_format | Article |
| series | Revista da Sociedade Brasileira de Medicina Tropical |
| spelling | doaj.art-374ca4bfcddd440281b14d6c0a9479f52024-02-27T07:39:41ZengSociedade Brasileira de Medicina Tropical (SBMT)Revista da Sociedade Brasileira de Medicina Tropical1678-98492024-02-015710.1590/0037-8682-0045-2024Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - BrazilIgor Monteiro Lima Martinshttps://orcid.org/0000-0002-6126-3387Alfredo Maurício Batista de Paulahttps://orcid.org/0000-0002-8715-0030Antônio Prates Caldeirahttps://orcid.org/0000-0002-9990-9083Lanuza Borges Oliveirahttps://orcid.org/0000-0003-0001-654XLuciano Freitas Fernandeshttps://orcid.org/0000-0001-8888-2957ABSTRACT Background: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. Methods: This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. Results: The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. Conclusions: Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822024000100401&tlng=enLeishmaniasisVisceralSurvivalPrognosisPublic Health |
| spellingShingle | Igor Monteiro Lima Martins Alfredo Maurício Batista de Paula Antônio Prates Caldeira Lanuza Borges Oliveira Luciano Freitas Fernandes Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil Revista da Sociedade Brasileira de Medicina Tropical Leishmaniasis Visceral Survival Prognosis Public Health |
| title | Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil |
| title_full | Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil |
| title_fullStr | Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil |
| title_full_unstemmed | Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil |
| title_short | Factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern Minas Gerais - Brazil |
| title_sort | factors associated with survival in patients with visceral leishmaniasis treated at a reference hospital in northern minas gerais brazil |
| topic | Leishmaniasis Visceral Survival Prognosis Public Health |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822024000100401&tlng=en |
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