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Lancet. 2000 Nov 18;356(9243):1767.
A clinical prediction rule for nerve-function impairment in leprosy patients.
The Danish-Bangladesh Leprosy Mission, Nilphamarl, Bangladesh. richard@crofts32.freeserve.co.uk
BACKGROUND: Nerve-function impairment (NFI) commonly occurs during or after chemotherapy in leprosy and is the key pathological process leading to disability and handicap. We describe the development of a simple clinical prediction rule for estimating the risk of NFI occurrence. METHODS: New leprosy cases who presented to a centre in Bangladesh were recruited and followed up for 2 years in a field setting. We used multivariable regression analysis by Cox's proportional hazards model to identify predictive variables for NFI. Discriminative ability was measured by a concordance statistic. Internal validity was assessed with bootstrap resampling techniques. FINDINGS: 2510 patients were followed up for 2 years, 166 developed NFI. A simple model was developed with leprosy group (either paucibacillary leprosy [PB] or multibacillary leprosy [MB]) and the presence of any nerve-function loss at registration as predictive variables. Patients with PB leprosy and no nerve-function loss had a 1.3% (95% CI 0.8-1.8%) risk of developing NFI within 2 years of registration; patients with PB leprosy and nerve-function loss, or patients with MB leprosy and no nerve-function loss had a 16.0% (12-20%) risk; and patients with MB leprosy with nerve-function loss had a 65% (56-73%) risk. INTERPRETATION: Our prediction rule can be used to plan surveillance of new leprosy patients. Patients at low risk of NFI may need no follow-up beyond their course of chemotherapy (6 months); patients with intermediate risk need a minimum of 1 year of surveillance; and patients with high risk should have at least 2 years of surveillance for new NFI. Current recommendations for surveillance of patients with leprosy (for the duration of chemotherapy only) exclude an important group of patients who are at risk of developing NFI after completion of treatment.
PMID: 10821364 [PubMed - indexed for MEDLINE]
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Cited by 3 PubMed Central articles
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Preventing nerve function impairment in leprosy: validation and updating of a prediction rule.
Schuring RP, Richardus JH, Steyerberg EW, Pahan D, Faber WR, Oskam L.
PLoS Negl Trop Dis. 2008; 2(8):e283. Epub 2008 Aug 27.
[PLoS Negl Trop Dis. 2008]
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Selection of antigens and development of prototype tests for point-of-care leprosy diagnosis.
Duthie MS, Ireton GC, Kanaujia GV, Goto W, Liang H, Bhatia A, Busceti JM, Macdonald M, Neupane KD, Ranjit C, et al.
Clin Vaccine Immunol. 2008 Oct; 15(10):1590-7. Epub 2008 Aug 20.
[Clin Vaccine Immunol. 2008]
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Steroid prophylaxis for prevention of nerve function impairment in leprosy: randomised placebo controlled trial (TRIPOD 1).
Smith WC, Anderson AM, Withington SG, van Brakel WH, Croft RP, Nicholls PG, Richardus JH.
BMJ. 2004 Jun 19; 328(7454):1459. Epub 2004 May 24.
[BMJ. 2004]