E B Brickley, E Kabyemela, J D Kurtis, M Fried, A M Wood, P E Duffy
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引用次数: 3
摘要
作为一项调查个性化医疗方法是否对降低幼儿疟疾相关死亡率有价值的试点研究,我们评估了母亲-后代疟疾研究项目出生队列(坦桑尼亚Muheza, 2002-2006)在分娩时收集的问卷和生物标志物数据,作为儿科严重疟疾贫血的潜在预后标志物。严重疟疾性贫血,这里定义为恶性疟原虫感染并伴有血红蛋白水平低于50 g/L,是高传播地区危及生命的疟疾的主要表现。对于本研究样本,结合脐带血白细胞介素-1β水平的预测模型对严重疟疾性贫血风险的c -指数最强,为0.77 (95% CI 0.70-0.84),而基于性别、妊娠、分娩时传播季节和蚊帐的实用模型的c -指数更温和,为0.63 (95% CI 0.54-0.71)。尽管需要更多的研究(理想情况下纳入更大的样本量和更高的事件/预测者比率)来从外部验证这些预测模型,但这些发现证明了一个概念,即可以制定基于风险评分的筛查方案,以避免儿童早期出现严重疟疾病例。
Developing a novel risk prediction model for severe malarial anemia.
As a pilot study to investigate whether personalized medicine approaches could have value for the reduction of malaria-related mortality in young children, we evaluated questionnaire and biomarker data collected from the Mother Offspring Malaria Study Project birth cohort (Muheza, Tanzania, 2002-2006) at the time of delivery as potential prognostic markers for pediatric severe malarial anemia. Severe malarial anemia, defined here as a Plasmodium falciparum infection accompanied by hemoglobin levels below 50 g/L, is a key manifestation of life-threatening malaria in high transmission regions. For this study sample, a prediction model incorporating cord blood levels of interleukin-1β provided the strongest discrimination of severe malarial anemia risk with a C-index of 0.77 (95% CI 0.70-0.84), whereas a pragmatic model based on sex, gravidity, transmission season at delivery, and bed net possession yielded a more modest C-index of 0.63 (95% CI 0.54-0.71). Although additional studies, ideally incorporating larger sample sizes and higher event per predictor ratios, are needed to externally validate these prediction models, the findings provide proof of concept that risk score-based screening programs could be developed to avert severe malaria cases in early childhood.