Risk Factors for Adverse Prognosis and Death in American Visceral Leishmaniasis: A Meta-analysis

Abstract

BackgroundIn 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 FindingsThe 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 <5 and 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/SignificanceIntegration 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.

Leishmaniasis in Thailand: A Review of Causative Agents and Situations

“…VL causes a broad range of symptoms from asymptomatic to a fatal outcome. 2,3 Symptoms depend on host immunity and species of the parasite. [3][4][5] Concomitant human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) not only increases the risk of active VL but also results in poor responses to treatment.…”

Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software

“…In a recent meta-analysis, jaundice, thrombocytopenia, hemorrhage, human immunodefi ciency virus-1 (HIV-1) co-infection, diarrhea, age <5 years or >40-50 years, severe neutropenia, dyspnea, and bacterial infections were important risk factors for VL-related death. Edema and low hemoglobin concentration were also associated with unfavorable outcomes (29) . However, most prognostic studies did not validate the scores.…”

Epidemiologia da leishmaniose visceral em Bauru, São Paulo, no período de 2004 a 2012: um estudo descritivo

“…7 Frequentemente, os exames complementares evidenciam, em diferentes graus, anemia, trombocitopenia, leucopenia, hipoalbuminemia e hipergamaglobulinemia. 8 Quando não tratada, a LV quase sempre evolui para óbito, 9 e mesmo quando tratada, a doença pode resultar em taxas de letalidade ao redor de 10 a 20%. 10 Frequentemente, o óbito é determinado por infecções bacterianas e/ou hemorragias.…”