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Prognostic factors for mortality among patients with visceral leishmaniasis in East Africa: Systematic review and meta-analysis

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  • Charles Abongomera
  • Saskia van Henten
  • Florian Vogt
  • Jozefien Buyze
  • Kristien Verdonck
  • Johan van Griensven

Abstract

Background: Visceral leishmaniasis (VL) is a vector-borne disease that is deadly if left untreated. Understanding which factors have prognostic value may help to focus clinical management and reduce case fatality. However, information about prognostic factors is scattered and conflicting. We conducted a systematic review and meta-analysis to identify prognostic factors for mortality among VL patients in East Africa. Methodology/Principal findings: The review protocol was registered in PROSPERO (CRD42016043112). We included studies published in English after 1970 describing VL patients treated in East African health facilities. To be included, studies had to report on associations between clinical or laboratory factors and mortality during admission or during VL treatment, with a minimal study size of ten patients. Conference abstracts and evaluations of genetic or immunological prognostic factors were excluded. We searched for studies in MEDLINE and four other databases in December 2018. To assess the risk of bias in observational studies and clinical trials, we used the Quality in Prognostic Studies (QUIPS) tool. We included 48 studies in the systematic review, describing 150,072 VL patients of whom 7,847 (5.2%) died. Twelve prognostic factors were evaluated in five or more studies and these results were submitted to meta-analysis producing one pooled crude odds ratio (OR) per prognostic factor. The following factors were strongly (OR>3) and significantly (P-value 45 years (OR = 3.69), oedema (OR = 3.52), bleeding (OR = 3.37), and haemoglobin ≤6.5 g/dl (OR = 3.26). Factors significantly and moderately (OR between one and three) associated with death were severe malnutrition, long duration of illness, young age (

Suggested Citation

  • Charles Abongomera & Saskia van Henten & Florian Vogt & Jozefien Buyze & Kristien Verdonck & Johan van Griensven, 2020. "Prognostic factors for mortality among patients with visceral leishmaniasis in East Africa: Systematic review and meta-analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(5), pages 1-19, May.
    • Handle: RePEc:plo:pntd00:0008319
    DOI: 10.1371/journal.pntd.0008319
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    References listed on IDEAS

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    1. Suzette S Kämink & Simon M Collin & Tim Harrison & Francis Gatluak & Abdul Wasay Mullahzada & Koert Ritmeijer, 2017. "A clinical severity scoring system for visceral leishmaniasis in immunocompetent patients in South Sudan," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(10), pages 1-15, October.
    2. George Peat & Richard D Riley & Peter Croft & Katherine I Morley & Panayiotis A Kyzas & Karel G M Moons & Pablo Perel & Ewout W Steyerberg & Sara Schroter & Douglas G Altman & Harry Hemingway & for th, 2014. "Improving the Transparency of Prognosis Research: The Role of Reporting, Data Sharing, Registration, and Protocols," PLOS Medicine, Public Library of Science, vol. 11(7), pages 1-8, July.
    3. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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