medRxiv : the preprint server for health sciences · 2026
Distance from tertiary care, pericardial effusion, and nutritional status predict all-cause mortality among Malawian children with rheumatic heart disease.
СтатьяПрепринтНазвание и аннотация: Перевод в очереди
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Olsen Jillian, Chimalizeni Yamikani, Carapetis Jonathan, Chiume Msandeni, Gunter Sarah Murphy, Hosseinipour Mina, Kazembe Peter, Lahiri Subhrajit, Mkaliainga Treasure, Murray Kristy O, Penny Daniel, Tambala Tayamika, Vinnakota Anirudh, Sanyahumbi Amy
Аннотация
BACKGROUND: This study of Malawian children with rheumatic heart disease (RHD) sought to detect demographic, clinical, and echocardiographic risk factors for mortality.
METHODS: Pediatric patients with RHD were recruited from March to October, 2018 from clinic rosters and inpatient consults in Lilongwe and Blantyre, Malawi. An echocardiogram was performed upon study enrollment. Cox regression analyses were performed to assess for factors associated with mortality over nearly 2 years of follow-up.
RESULTS: Of 118 patients, nearly two-thirds were female (64.4%) and median age was 12 (IQR 10-14). Just under half (47.0%) lived >40km from a tertiary care center. There was a high prevalence of severe mitral regurgitation (65.3%), and pericardial effusion was present in 18.6%. Nearly a quarter (23.7%) died during follow-up. In univariable Cox regression, living >40km from tertiary care, living in a remote area, moderate or severe malnutrition, taking a beta blocker, severe mitral stenosis, any severe valve disease, severe left atrial enlargement, and presence of a pericardial effusion were statistically significant risk factors for mortality (p<0.05). In the adjusted model, living >40km from tertiary care (HR 2.66, CI 1.06-6.07, p=0.037), malnutrition (mild HR 3.92, CI 1.03-14.91, p=0.045); moderate HR 7.41, CI 1.92-28.54, p=0.004; severe HR 4.91, CI 1.44-16.71, p=0.011), beta blocker use (HR 4.62, CI 1.63-13.10, p=0.004), and presence of a pericardial effusion (HR 6.96, CI 3.00-16.13, p<0.001) remained independent risk factors for mortality.
CONCLUSIONS: This study of Malawian children emphasizes the dire prognosis of RHD in under-resourced settings and provides potential area of focus for targeted intervention.
METHODS: Pediatric patients with RHD were recruited from March to October, 2018 from clinic rosters and inpatient consults in Lilongwe and Blantyre, Malawi. An echocardiogram was performed upon study enrollment. Cox regression analyses were performed to assess for factors associated with mortality over nearly 2 years of follow-up.
RESULTS: Of 118 patients, nearly two-thirds were female (64.4%) and median age was 12 (IQR 10-14). Just under half (47.0%) lived >40km from a tertiary care center. There was a high prevalence of severe mitral regurgitation (65.3%), and pericardial effusion was present in 18.6%. Nearly a quarter (23.7%) died during follow-up. In univariable Cox regression, living >40km from tertiary care, living in a remote area, moderate or severe malnutrition, taking a beta blocker, severe mitral stenosis, any severe valve disease, severe left atrial enlargement, and presence of a pericardial effusion were statistically significant risk factors for mortality (p<0.05). In the adjusted model, living >40km from tertiary care (HR 2.66, CI 1.06-6.07, p=0.037), malnutrition (mild HR 3.92, CI 1.03-14.91, p=0.045); moderate HR 7.41, CI 1.92-28.54, p=0.004; severe HR 4.91, CI 1.44-16.71, p=0.011), beta blocker use (HR 4.62, CI 1.63-13.10, p=0.004), and presence of a pericardial effusion (HR 6.96, CI 3.00-16.13, p<0.001) remained independent risk factors for mortality.
CONCLUSIONS: This study of Malawian children emphasizes the dire prognosis of RHD in under-resourced settings and provides potential area of focus for targeted intervention.