Prognostic factors associated with death from visceral leishmaniasis: a case-control study in Brazil

Abstract

Background The aim of this study was to identify the prognostic factors associated with death from visceral leishmaniasis (VL) considering the clinical evolution of patients through a case-control study. Methods We randomly selected 180 cases (death caused by VL) and 180 controls (cured) from Belo Horizonte's hospitals in Brazil, according to data found in the patients' medical records. Five models of multivariate logistic regression were performed following the chronological order of the variables between the onset of the symptoms and evolution of the VL cases. Results Considering the multivariate models and the stages of clinical evolution of VL, the prognostic factors associated with death are: age >60 y, minor hemorrhagic phenomena, increased abdominal volume, jaundice, dyspnea, malnutrition, TB, billirubin >2 mg/dL, Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT) >100 U/L, leukocytes >7000/mm3, hemoglobin <7 g/dL, platelets <50 000/mm3 and infection without defined focus and bleeding. Conclusions Knowledge regarding the prognostic factors associated with death from VL in different stages of the disease in large Brazilian urban centers such as Belo Horizonte may help optimize patient management strategies and contribute to reduce the high fatality rates in these cities.

Prognostic Models Predicting Clinical Outcomes in Patients Diagnosed with Visceral Leishmaniasis: A Systematic Review

“…We excluded unpublished manuscripts, including conference abstracts and educational theses, given concerns about quality and difficulty in accessing the original works. Furthermore, in keeping with our prespecified inclusion criteria, this review excluded studies diagnostic models (47,48), models that only evaluated single predictors (49)(50)(51), prognostic factor studies (19,(52)(53)(54), or registered, but unpublished prognostic model studies (for example, NCT05602610). Evaluation of the implementation of prognostic models in current practice and policy was also considered outside the scope of this review.…”

Mathematical Modelling Using Predictive Biomarkers for the Outcome of Canine Leishmaniasis upon Chemotherapy

“…Until recently, most studies of prognostic factors for treatment success or failure in leishmaniasis were restricted to humans [33][34][35][36][37], and the infected dog has been seen only as a protozoan reservoir. This is an innovative longitudinal study of prognostic factors in L. infantum naturally infected dogs under treatment that resulted in a clear distinction of two profiles of CanL dogs that responded differently to the same antiparasitic therapy, based on their tissue parasite load reduction.…”

From Infection to Death: An Overview of the Pathogenesis of Visceral Leishmaniasis

“…Weight loss is also a common manifestation of VL, resulting from severe malnutrition [ 84 , 85 ]. Patients with VL-driven malnutrition are at higher risk of death [ 86 , 87 , 88 , 89 , 90 ]. While the mechanisms are unknown, there are at least three main possibilities to account for the weight loss, all linked to persistent systemic inflammation due to the production of proinflammatory cytokines, i.e., (a) loss of appetite as part of the illness following systemic inflammation [ 67 , 91 , 92 ]; (b) fever that sharply increases the consumption of energy [ 93 ]; and (c) acute phase response that increases muscle catabolism leading to sarcopenia, thereby making amino acids abundantly available for APR synthesis in the liver [ 94 , 95 , 96 ].…”

“…Stimulated neurons then send signals to a central-pattern generator, which coordinates the act of emesis and to the ventral medulla and hypothalamus, reaching the cortical brain areas [ 98 ]. Vomiting has been reported to be associated with increased mortality of VL patients in both Africa and Brazil [ 58 , 86 , 88 , 89 , 90 , 99 , 100 , 101 , 102 , 103 ]. In these patients, it is associated with higher concentrations of IL-6 according to uni- and multi-variate analyses [ 104 ].…”

“…Anemia is also a common clinical manifestation and a risk factor for poor outcome of VL [ 58 , 86 , 88 , 89 , 90 , 100 , 101 , 102 , 103 , 106 , 107 , 108 , 109 , 110 , 111 , 112 ]. It is typically due to iron deficiency, with hypochromia and microcytosis marked by a low serum iron concentration [ 113 ].…”