Does my patient have chronic Chagas disease? Development and temporal validation of a diagnostic risk score
Rev. Soc. Bras. Med. Trop
; 49(3): 329-340, tab, graf
Article
em En
| LILACS
| ID: lil-785782
Biblioteca responsável:
BR1.1
ABSTRACT
Abstract INTRODUCTION With the globalization of Chagas disease, unexperienced health care providers may have difficulties in identifying which patients should be examined for this condition. This study aimed to develop and validate a diagnostic clinical prediction model for chronic Chagas disease. METHODS This diagnostic cohort study included consecutive volunteers suspected to have chronic Chagas disease. The clinical information was blindly compared to serological tests results, and a logistic regression model was fit and validated. RESULTS The development cohort included 602 patients, and the validation cohort included 138 patients. The Chagas disease prevalence was 19.9%. Sex, age, referral from blood bank, history of living in a rural area, recognizing the kissing bug, systemic hypertension, number of siblings with Chagas disease, number of relatives with a history of stroke, ECG with low voltage, anterosuperior divisional block, pathologic Q wave, right bundle branch block, and any kind of extrasystole were included in the final model. Calibration and discrimination in the development and validation cohorts (ROC AUC 0.904 and 0.912, respectively) were good. Sensitivity and specificity analyses showed that specificity reaches at least 95% above the predicted 43% risk, while sensitivity is at least 95% below the predicted 7% risk. Net benefit decision curves favor the model across all thresholds. CONCLUSIONS:
A nomogram and an online calculator (available at http//shiny.ipec.fiocruz.br3838/pedrobrasil/chronic_chagas_disease_prediction/) were developed to aid in individual risk estimation.Palavras-chave
Texto completo:
1
Bases de dados:
LILACS
Assunto principal:
Doença de Chagas
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
Rev. Soc. Bras. Med. Trop
Assunto da revista:
MEDICINA TROPICAL
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Brasil