Preventing Nerve Function Impairment in Leprosy Validation and Updating of a Prediction Rule 英文参考文献.docVIP

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Preventing Nerve Function Impairment in Leprosy Validation and Updating of a Prediction Rule 英文参考文献.doc

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Preventing Nerve Function Impairment in Leprosy Validation and Updating of a Prediction Rule 英文参考文献

PreventingNerveFunctionImpairmentinLeprosy: ValidationandUpdatingofaPredictionRule RonP.Schuring1,JanH.Richardus2,EwoutW.Steyerberg2,DavidPahan3,WilliamR.Faber4 ,Linda Oskam1* 1KIT (Royal Tropical Institute) Biomedical Research, Amsterdam, The Netherlands, 2Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, 3Rural Health Program, The Leprosy Mission Bangladesh, Nilphamari, Bangladesh, 4Department of Dermatology, Amsterdam Medical Centre,Amsterdam,TheNetherlands Abstract Background:Tovalidateandupdateapredictionruleforestimatingtheriskofleprosy-relatednervefunctionimpairment (NFI). Methodology/Principal Findings: Prospective cohort using routinely collected data, in which we determined the discriminative ability of a previously published rule and an updated rule with a concordance statistic (c). Additional risk factorswereanalyzedwithaCoxproportionalhazardsregressionmodel.Thepopulationconsistedof1,037leprosypatients newly diagnosed between 2002 and 2003 in the health care facilities of the Rural Health Program in Nilphamari and RangpurdistrictsinnorthwestBangladesh.Theprimaryoutcomewasthetimeuntilthestartoftreatment.AnNFIeventwas definedasthedecisiontotreatNFIwithcorticosteroidsafterdiagnosis.NFIoccurredin115patients(13%;95%confidence interval 11%–16%). The original prediction rule had adequate discriminative ability (c=0.79), but could be improved by substitutingonepredictingvariable:‘long-standingnervefunctionimpairmentatdiagnosis’by‘anti-PGL-Iantibodies’.The adjusted prediction rule was slightly better (c=0.81) and identified more patients with NFI (80%) than the original predictionrule(72%). Conclusions/Significance: NFI can well be predicted by using the risk variables ‘leprosy classification’ and ‘anti-PGL-I antibodies’. Theuseof these twovariables that donot include NFIoffer thepossibility ofpredicting NFI,even beforeit occurs for thefirst time. Surveillance beyond thetreatmentperiod canbe targeted totho