title: Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis.
abstract: BACKGROUND
  In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented.
  
  
  RESULTS
  The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40-50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far.
  
  
  CONCLUSIONS
  Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil; Departamento Básico-Área da Saúde-Campus Governador Valadares, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brasil.
authors: Vinícius Silva
authors: VS
authors: Belo
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors: Claudio José
authors: CJ
authors: Struchiner
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil.
authors: David Soeiro
authors: DS
authors: Barbosa
authors: Departamento de Parasitologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.
authors: Bruno Warlley Leandro
authors: BW
authors: Nascimento
authors: Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janiero, Brasil.
authors: Marco Aurélio Pereira
authors: MA
authors: Horta
authors: Campus Centro-Oeste Dona Lindu, Universidade Federal de São João del Rei, Divinópolis, Minas Gerais, Brasil.
authors: Eduardo Sérgio
authors: ES
authors: da Silva
authors: Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil; Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brasil.
authors: Guilherme Loureiro
authors: GL
authors: Werneck
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007898:Leishmaniasis, Visceral / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult