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Abstract：
We conducted a retrospective study on mortality trends and risk factors in 781 naïve cases of advanced stage-2 sleeping sickness admitted between 1989 and 2012 at the National Reference Center for Human African Trypanosomiasis (HAT), Department of Neurology, Kinshasa University, Democratic Republic of Congo (DRC). Death was the outcome variable whereas age, gender, duration of disease, location of trypanosomes in body fluids, cytorachy, protidorachy, clinical status (assessed on a syndromic and functional basis) on admission, and treatment regimen were predictors in logistic regression models run at the 0.05 significance level. Death proportions were 17.2% in the standard melarsoprol schedule (3-series of intravenous melarsoprol on 3 successive days at 3.6 mg/kg/d, with a one-week interval between the series, ARS 9); 12.1% in the short schedule melarsoprol (10 consecutive days of intravenous melarsoprol at 2.2 mg/kg/d, ARS 10), 5.4% in the first-line eflornithine (14 days of eflornithine at 400 mg/kg/d in 4 infusions a day DFMO B), 9.1% in the NECT treatment regimen (eflornithine for 7 days at 400, mg/kg/d in 2 infusions a day combined with oral nifurtimox for 10 days at 15 mg/kg/d in 3 doses a day); and high (36%) in the group with select severely affected patients given eflornithine because of their clinical status on admission, at the time when this expensive drug was kept for treatment of relapses (14 days at 400 mg/kg/d in 4 infusions a day, DFMO A). After adjusting for treatment, death odds ratios were as follows: 10.40 [(95% CI: 6.55-16.51); p = .000] for clinical dysfunction (severely impaired clinical status) on admission, 2.14 [(95% CI: 1.35-3.39); p = .001] for high protidorachy, 1.99 [(95% CI: 1.18-3.37); p = .010] for the presence of parasites in the CSF and 1.70 [(95% CI: 1.03-2.81); p = .038] for high cytorachy. A multivariable analysis within treatment groups retained clinical status on admission (in ARS 9, ARS 10 and DFMO B groups) and high protidorachy (in ARS 10 and DFMO B groups) as significant predictors of death. The algorithm for initial clinical status assessment used in the present study may serve as the basis for further development of standardized assessment tools relevant to the clinical management of HAT and information exchange in epidemiological reports.
摘要：
我们对1989年至2012年在国家非洲锥虫病参考中心（HAT）收治的781例初治晚期2期昏睡病病例的死亡率趋势和危险因素进行了回顾性研究。神经内科,金沙萨大学，刚果民主共和国（DRC）。死亡是结果变量，而年龄，性别,疾病的持续时间，锥虫在体液中的位置，cytorachy,protidorachy,入院时的临床状态（根据综合征和功能进行评估），和治疗方案是在0.05显著性水平下运行的logistic回归模型的预测因子。标准melarosoprol时间表中的死亡比例为17.2％（连续3天以3.6mg/kg/d的剂量连续3天静脉注射melarosoprol，系列之间有一周的间隔，ARS9)；12.1%在短期治疗方案中(以2.2mg/kg/d的剂量连续10天静脉注射melarosoprol，ARS10),5.4％的一线依氟鸟氨酸（14天依氟鸟氨酸400mg/kg/d，每天4次输注DFMOB），在NECT治疗方案中为9.1％（依氟鸟氨酸治疗7天，每天2次输注mg/kg/d，每天3次口服硝呋替莫，每天15mg/kg/d，共10天）；在选择严重受影响的患者组中，由于入院时的临床状态，高（36％）在将这种昂贵的药物用于治疗复发时（每天4次输注，以400mg/kg/d的剂量14天，DFMOA）。调整治疗后，入院时临床功能障碍（临床严重受损）的死亡比值比如下：10.40[（95%CI：6.55-16.51）；p=.000]，2.14[(95%CI：1.35-3.39)；p=.001]1.99[（95％CI：1.18-3.37）；p=.010]对于CSF中存在寄生虫，而1.70[（95％CI：1.03-2.81）；p=.038]对于高膀胱。治疗组中的多变量分析保留了入院时的临床状态（ARS9，ARS10和DFMOB组）和高前驱体（ARS10和DFMOB组）作为死亡的重要预测因子。本研究中使用的初始临床状态评估算法可作为进一步开发与HAT临床管理和流行病学报告中信息交换相关的标准化评估工具的基础。
