A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan.
South Sudan is one of the most endemic countries for visceral leishmaniasis (VL), and is frequently affected by large epidemics. In resource-limited settings, clinicians require a simple clinical tool to identify VL patients who are at increased risk of dying, and who need specialised treatment with...
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ftdoajarticles:oai:doaj.org/article:5d255ce7fbe54e89b52387bc5645adb8 2023-05-15T15:16:35+02:00 A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. Suzette S Kämink Simon M Collin Tim Harrison Francis Gatluak Abdul Wasay Mullahzada Koert Ritmeijer 2017-10-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0005921 https://doaj.org/article/5d255ce7fbe54e89b52387bc5645adb8 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC5638606?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0005921 https://doaj.org/article/5d255ce7fbe54e89b52387bc5645adb8 PLoS Neglected Tropical Diseases, Vol 11, Iss 10, p e0005921 (2017) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2017 ftdoajarticles https://doi.org/10.1371/journal.pntd.0005921 2022-12-31T08:17:16Z South Sudan is one of the most endemic countries for visceral leishmaniasis (VL), and is frequently affected by large epidemics. In resource-limited settings, clinicians require a simple clinical tool to identify VL patients who are at increased risk of dying, and who need specialised treatment with liposomal amphotericin B and other supportive care. The aim of this study was to develop and validate a clinical severity scoring system based on risk factors for death in VL patients in South Sudan.A retrospective analysis was conducted of data from a cohort of 6,633 VL patients who were treated in the Médecins Sans Frontières (MSF) hospital in Lankien between July 2013 and June 2015. Risk factors for death during treatment were identified using multivariable logistic regression models, and the regression coefficients were used to develop a severity scoring system. Sensitivity and specificity of score cut-offs were assessed by receiver operating characteristic (ROC) analysis.In multivariable models, risk factors for death in adult VL patients were: anaemia (odds ratio (OR) 4.46 (95% CI 1.58-12.6) for Hb <6g/dL compared with ≥9g/dL), nutritional status (OR 4.84 (2.09-11.2) for BMI <13 kg/m2 compared with ≥16 kg/m2), weakness (OR 4.20 (1.82-9.73) for collapsed compared with normal weakness), jaundice (OR 3.41 (1.17-9.95)), and oedema/ascites (OR 4.86 (1.67-14.1)). For children and adolescents the risk factors were: age (OR 10.7 (6.3-18.3) for age <2 years compared with 6-18 years), anaemia (OR 7.76 (4.15-14.5) for Hb <6g/dL compared with ≥9g/dL), weakness (OR 3.13 (22.8-105.2) for collapsed compared with normal weakness), and jaundice (OR 12.8 (4.06-40.2)). Severity scoring predictive ability was 74.4% in adults and 83.4% in children and adolescents.Our evidenced-based severity scoring system demonstrated sufficient predictive ability to be operationalised as a clinical tool for rational allocation of treatment to VL patients at MSF centres in South Sudan. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 11 10 e0005921 |
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Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Suzette S Kämink Simon M Collin Tim Harrison Francis Gatluak Abdul Wasay Mullahzada Koert Ritmeijer A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
South Sudan is one of the most endemic countries for visceral leishmaniasis (VL), and is frequently affected by large epidemics. In resource-limited settings, clinicians require a simple clinical tool to identify VL patients who are at increased risk of dying, and who need specialised treatment with liposomal amphotericin B and other supportive care. The aim of this study was to develop and validate a clinical severity scoring system based on risk factors for death in VL patients in South Sudan.A retrospective analysis was conducted of data from a cohort of 6,633 VL patients who were treated in the Médecins Sans Frontières (MSF) hospital in Lankien between July 2013 and June 2015. Risk factors for death during treatment were identified using multivariable logistic regression models, and the regression coefficients were used to develop a severity scoring system. Sensitivity and specificity of score cut-offs were assessed by receiver operating characteristic (ROC) analysis.In multivariable models, risk factors for death in adult VL patients were: anaemia (odds ratio (OR) 4.46 (95% CI 1.58-12.6) for Hb <6g/dL compared with ≥9g/dL), nutritional status (OR 4.84 (2.09-11.2) for BMI <13 kg/m2 compared with ≥16 kg/m2), weakness (OR 4.20 (1.82-9.73) for collapsed compared with normal weakness), jaundice (OR 3.41 (1.17-9.95)), and oedema/ascites (OR 4.86 (1.67-14.1)). For children and adolescents the risk factors were: age (OR 10.7 (6.3-18.3) for age <2 years compared with 6-18 years), anaemia (OR 7.76 (4.15-14.5) for Hb <6g/dL compared with ≥9g/dL), weakness (OR 3.13 (22.8-105.2) for collapsed compared with normal weakness), and jaundice (OR 12.8 (4.06-40.2)). Severity scoring predictive ability was 74.4% in adults and 83.4% in children and adolescents.Our evidenced-based severity scoring system demonstrated sufficient predictive ability to be operationalised as a clinical tool for rational allocation of treatment to VL patients at MSF centres in South Sudan. |
format |
Article in Journal/Newspaper |
author |
Suzette S Kämink Simon M Collin Tim Harrison Francis Gatluak Abdul Wasay Mullahzada Koert Ritmeijer |
author_facet |
Suzette S Kämink Simon M Collin Tim Harrison Francis Gatluak Abdul Wasay Mullahzada Koert Ritmeijer |
author_sort |
Suzette S Kämink |
title |
A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. |
title_short |
A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. |
title_full |
A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. |
title_fullStr |
A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. |
title_full_unstemmed |
A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan. |
title_sort |
clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in south sudan. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2017 |
url |
https://doi.org/10.1371/journal.pntd.0005921 https://doaj.org/article/5d255ce7fbe54e89b52387bc5645adb8 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 11, Iss 10, p e0005921 (2017) |
op_relation |
http://europepmc.org/articles/PMC5638606?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0005921 https://doaj.org/article/5d255ce7fbe54e89b52387bc5645adb8 |
op_doi |
https://doi.org/10.1371/journal.pntd.0005921 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
11 |
container_issue |
10 |
container_start_page |
e0005921 |
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1766346874147569664 |