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https://www.arca.fiocruz.br/handle/icict/58448
RISK SCORE FOR PREDICTING 2-YEAR MORTALITY IN PATIENTS WITH CHAGAS CARDIOMYOPATHY FROM ENDEMIC AREAS: SAMI-TROP COHORT STUDY
Autor(es)
Oliveira, Claudia Di Lorenzo
Nunes, Maria Carmo P
Colosimo, Enrico Antonio
Lima, Emilly Malveira de
Cardoso, Clareci S
Ferreira, Ariela Mota
Oliveira, Lea Campos de
Moreira, Carlos Henrique Valente
Bierrenbach, Ana Luiza
Haikal, Desireé Sant Ana
Peixoto, Sérgio William Viana
Costa, Maria Fernanda Furtado de Lima
Sabino, Ester Cerdeira
Ribeiro, Antonio Luiz P
Nunes, Maria Carmo P
Colosimo, Enrico Antonio
Lima, Emilly Malveira de
Cardoso, Clareci S
Ferreira, Ariela Mota
Oliveira, Lea Campos de
Moreira, Carlos Henrique Valente
Bierrenbach, Ana Luiza
Haikal, Desireé Sant Ana
Peixoto, Sérgio William Viana
Costa, Maria Fernanda Furtado de Lima
Sabino, Ester Cerdeira
Ribeiro, Antonio Luiz P
Afiliação
Federal University of São João del-Rei. Divinópolis, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Hospital das Clínicas. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Instituto de Ciência Exatas. Department of Statistics. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Instituto de Ciência Exatas. Department of Statistics. Belo Horizonte, MG, Brazil.
Federal University of São João del-Rei. Divinópolis, MG, Brazil.
Health Science Program Universidade Estadual de Montes Claros Montes Claros Brazil.
Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Laboratório de Investigação Médica. São Paulo, SP, Brazil.
Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Laboratório de Investigação Médica. São Paulo, SP, Brazil.
Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil.
Health Science Program Universidade Estadual de Montes Claros Montes Claros Brazil.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.
Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical e Departamento de Moléstias Infecciosas e Parasitarias. São Paulo, SP, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Hospital das Clínicas. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Hospital das Clínicas. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Instituto de Ciência Exatas. Department of Statistics. Belo Horizonte, MG, Brazil.
Universidade Federal de Minas Gerais. Instituto de Ciência Exatas. Department of Statistics. Belo Horizonte, MG, Brazil.
Federal University of São João del-Rei. Divinópolis, MG, Brazil.
Health Science Program Universidade Estadual de Montes Claros Montes Claros Brazil.
Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Laboratório de Investigação Médica. São Paulo, SP, Brazil.
Universidade de São Paulo. Faculdade de Medicina. Hospital das Clinicas. Laboratório de Investigação Médica. São Paulo, SP, Brazil.
Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil.
Health Science Program Universidade Estadual de Montes Claros Montes Claros Brazil.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.
Fundação Oswaldo Cruz. Instituto René Rachou. Belo Horizonte, MG, Brazil.
Universidade de São Paulo. Faculdade de Medicina. Instituto de Medicina Tropical e Departamento de Moléstias Infecciosas e Parasitarias. São Paulo, SP, Brazil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Hospital das Clínicas. Belo Horizonte, MG, Brazil.
Resumo em Inglês
Background Risk stratification of Chagas disease patients in the limited-resource setting would be helpful in crafting management strategies. We developed a score to predict 2-year mortality in patients with Chagas cardiomyopathy from remote endemic areas. Methods and Results This study enrolled 1551 patients with Chagas cardiomyopathy from Minas Gerais State, Brazil, from the SaMi-Trop cohort (The SÃO Paulo-Minas Gerais Tropical Medicine Research Center). Clinical evaluation, ECG, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were performed. A Cox proportional hazards model was used to develop a prediction model based on the key predictors. The end point was all-cause mortality. The patients were classified into 3 risk categories at baseline (low, <2%; intermediate, >= 2% to 10%; high, >= 10%). External validation was performed by applying the score to an independent population with Chagas disease. After 2 years of follow-up, 110 patients died, with an overall mortality rate of 3.505 deaths per 100 person-years. Based on the nomogram, the independent predictors of mortality were assigned points: age (10 points per decade), New York Heart Association functional class higher than I (15 points), heart rate >= 80 beats/min (20 points), QRS duration >= 150 ms (15 points), and abnormal NT-proBNP adjusted by age (55 points). The observed mortality rates in the low-, intermediate-, and high-risk groups were 0%, 3.6%, and 32.7%, respectively, in the derivation cohort and 3.2%, 8.7%, and 19.1%, respectively, in the validation cohort. The discrimination of the score was good in the development cohort (C statistic: 0.82), and validation cohort (C statistic: 0.71). Conclusions In a large population of patients with Chagas cardiomyopathy, a combination of risk factors accurately predicted early mortality. This helpful simple score could be used in remote areas with limited technological resources.
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