The Cox model of predicting mortality among melioidosis patients in Northern Malaysia: A retrospective study.
Medicine (Baltimore)
; 100(25): e26160, 2021 Jun 25.
Article
in En
| MEDLINE
| ID: mdl-34160382
ABSTRACT
ABSTRACT Melioidosis is an infectious disease that is initiated by a bacteria recognized as Burkholderia pseudomallei. Despite the high fatality rate from melioidosis, there is a minimal published study about the disease in Malaysia.This study aimed to identify the prognostic factors of mortality among melioidosis patients in northern Malaysia.All inpatient patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis during the period 2014 to 2017 were included in the study. The study retrospectively collected 510 melioidosis patients from the Melioidosis Registry. Hazard ratio (HR) used in advanced multiple Cox regression was used to obtain the final model of prognostic factors of melioidosis. The analysis was performed using STATA/SE 14.0 for Windows software.From the results, among the admitted patients, 50.1% died at the hospital. The mean age for those who died was 55âyears old, and they were mostly male. The most common underlying disease was diabetes mellitus (69.8%), followed by hypertension (32.7%). The majority of cases (86.8%) were bacteremic. The final Cox model identified 5 prognostic factors of mortality among melioidosis patients. The factors were diabetes mellitus, type of melioidosis, platelet count, white blood cell count, and urea value. The results showed that bacteremic melioidosis increased the risk of dying by 3.47 (HR 3.47, 95% confidence intervals [CI] 1.67-7.23, Pâ=â.001) compared to non-bacteremic melioidosis. Based on the blood investigations, the adjusted HRs from the final model showed that all 3 blood investigations were included as the prognostic factors for the disease (low platelet HRâ=â1.76, 95% CI 1.22-2.54, Pâ=â.003; high white blood cell HRâ=â1.49, 95% CI 1.06-2.11, Pâ=â.023; high urea HRâ=â2.92, 95% CI 1.76-4.85, Pâ<â.001; and low level of urea HRâ=â2.69, 95% CI 1.69-4.29, Pâ<â.001). By contrast, melioidosis patients with diabetic had 30.0% lower risk of dying from melioidosis compared to those with non-diabetic (HRâ=â0.70, 95% CI 0.52-0.94, Pâ=â.016).Identifying the prognostic factors of mortality in patients with melioidosis allows a guideline of early management in these patients, which may improve patient's survival.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Burkholderia pseudomallei
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Diabetes Mellitus
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Hypertension
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Melioidosis
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Anti-Bacterial Agents
Type of study:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Country/Region as subject:
Asia
Language:
En
Journal:
Medicine (Baltimore)
Year:
2021
Document type:
Article