Defining Severe Shigellosis in the Enterics for Global Health Study: A Comparison of Leading Diarrhea Severity Definitions Among Children With Shigella Diarrhea.
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Schultes Olivia Lang, Hotwani Aneeta, Pavlinac Patricia B, Hossain M Jahangir, Nasrin Dilruba, Omore Richard, Khanam Farhana, Kawonga Flywell, Garcia Bardales Paul F, Atlas Hannah E, Awuor Alex O, Badji Henry, Conteh Bakary, Cornick Jennifer, Feutz Erika, Galagan Sean R, Gitteh Ensa, Houpt Eric R, Iqbal Junaid, Islam Sadia, Kabir Furqan, Keita Adama Mamby, Liu Jie, Mategula Donnie, Mhango Chimwemwe, Mosharraf Md Parvej, Ogwel Billy, Okonji Caleb, Onwuchekwa Uduma Uma, Pinedo Vasquez Tackeshy, Raz S M Azadul Alam, Romaina-Cachique Lucero, Schiaffino Francesca, Tapia Milagritos D, Tennant Sharon M, Yousafzai Mohammad Tahir, Jere Khuzwayo C, Kosek Margaret N, Sow Samba O, Platts-Mills James A, Qamar Farah Naz, Rogawski McQuade Elizabeth T, Kotloff Karen L, Ochieng John Benjamin, Qadri Firdausi, EFGH Consortium
Аннотация
METHODS: Six- to 35-month-old children presenting with diarrhea were enrolled at 7 EFGH study sites. Among children with Shigella, 6 diarrhea severity definitions (Global Enteric Multicenter Study [GEMS] moderate-to-severe diarrhea [MSD], modified Vesikari score [MVS], MVS +/- dysentery, Clark score, MAL-ED score, and Shigella mortality score) were examined against 2 outcomes: change in length/height-for-age z-score (ΔLAZ/HAZ) over 3 months and death or hospitalization within 14 days. We compared the performance of each severity score to predict outcomes using linear regression and measures of diagnostic accuracy.
RESULTS: Moderate or severe diarrhea was negatively associated with ΔLAZ/HAZ by MVS (-0.07 z-score, 95% CI -0.10 to -0.03), MVS +/- dysentery (-0.05, 95% CI -0.09 to -0.02), and MAL-ED score (-0.04, 95% CI -0.07 to 0.00). GEMS MSD (93.6%), MAL-ED (87.2%), MVS +/- dysentery (85.1%), and MVS (80.9%) had high sensitivity in predicting death or hospitalization.
CONCLUSIONS: MVS, MVS +/- dysentery, and MAL-ED score identified adverse outcomes following Shigella diarrhea and are viable options for a vaccine trial case definition.