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Building prognostic models for adverse outcomes in a prospective cohort of hospitalised patients with acute leptospirosis infection in the Philippines

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Lee, Nathaniel, Kitashoji, Emi, Koizumi, Nobuo, Lacuesta, Talitha Lea V, Ribo, Maricel R, Dimaano, Efren M, Saito, Nobuo, Suzuki, Motoi, Ariyoshi, Koya and Parry, Christopher (2018) 'Building prognostic models for adverse outcomes in a prospective cohort of hospitalised patients with acute leptospirosis infection in the Philippines'. Transactions of the Royal Society of Tropical Medicine and Hygiene.

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Abstract

Leptospirosis is endemic to the Philippines. Ten per cent of cases will develop severe or fatal disease. Predicting progression to severity is difficult. Risk factors have been suggested, but few attempts have been made to create predictive models to guide clinical decisions. We present two models to predict the risk of mortality and progression to severe disease. Data was used from a prospective cohort study conducted between 2011 and 2013 in San Lazaro Hospital, Manila. Predictive factors were identified from a literature review. A strategy utilizing backwards stepwise-elimination and multivariate fractional polynomials identified key predictive factors. A total of 203 patients met the inclusion criteria. The overall mortality rate was 6.84%. Multivariable logistic regression revealed that neutrophil counts [OR 1.38, 95% CI 1.15–1.67] and platelet counts [OR 0.99, 95% CI 0.97–0.99] were predictive for risk of mortality. Multivariable logistic regression revealed that male sex (OR 3.29, 95% CI 1.22–12.57) and number of days between symptom onset and antibiotic use (OR 1.28, 95% CI 1.08–1.53) were predictive for risk of progression to severe disease. The multivariable prognostic models for the risks of mortality and progression to severe disease developed could be useful in guiding clinical management by the early identification of patients at risk of adverse outcomes.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 900 Public health statistics
WC Communicable Diseases > Infection. Bacterial Infections > Other Bacterial Infections. Zoonotic Bacterial Infections > WC 420 Leptospirosis. Weil disease
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/trstmh/try015
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 13 Mar 2018 12:11
Last Modified: 06 Mar 2019 02:02
URI: http://archive.lstmed.ac.uk/id/eprint/8342

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