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PubMed2006

Lateral epicondylitis in general practice: course and prognostic indicators of outcome.

OBJECTIVE: To investigate the course of lateral epicondylitis and identify prognostic indicators associated with short- and longterm outcome of pain intensity. METHODS: We prospectively followed patients (n = 349) from 2 randomized controlled trials investigating conservative interventions for lateral epicondylitis in primary care. Uni- and multivariate linear regression analyses were used to investigate the association between potential prognostic indicators and pain intensity (0-100 point scale) measured at 1, 6, and 12 months after randomization. Potential prognostic factors were duration of elbow complaints, concomitant neck pain, concomitant shoulder pain, previous elbow complaints, baseline pain scores, age, gender, involvement of dominant side, social class, and work status. The variables "study" and "treatment" were included as covariates in all models. RESULTS: Pain scores at 1 month followup were higher in patients with severe pain, a long duration of elbow complaints, and concomitant shoulder pain. At 12 month followup, the only different prognostic indicator for poor outcome was concomitant neck pain, in place of shoulder pain. Patients from higher social classes reported lower pain scores at 12 month followup than patients from lower social classes. CONCLUSIONS: Lateral epicondylitis seems to be a self-limiting condition in most patients. Long duration of elbow complaints, concomitant neck pain, and severe pain at presentation are associated with poor outcome at 12 months. Our results will help care providers give patients accurate information regarding their prognosis and assist in medical decision-making.

Adult↗
PubMed2004

Serum LD1 isoenzyme and blood lymphocyte subsets as prognostic indicators for severe acute respiratory syndrome.

BACKGROUND: The pathophysiology of severe acute respiratory syndrome (SARS) is at present poorly understood, but advanced age and serum total lactate dehydrogenase (LD) activity >300 U L(-1) have been associated with adverse clinical outcomes. Blood leucocytes and lymphocyte subsets were reported to decrease, respectively, in 47% and up to 100% of 38 patients in Beijing. However, their prognostic implications have not been thoroughly investigated. OBJECTIVE: To investigate serum total LD, LD isoenzymes, and other parameters including blood lymphocyte subsets as prognostic indicators in SARS patients for adverse clinical outcomes in terms of admission to intensive care unit (ICU) and death. DESIGN: Retrospective analysis. SUBJECTS AND METHODS: A total of 109 patients with a clinical diagnosis of SARS according to the modified World Health Organization case definition of SARS were recruited from two major acute hospitals in Hong Kong. They were either involved in the initial outbreak of SARS, or cases from the community outbreak of Amoy Gardens between 10 March and 5 May 2003. The clinical diagnosis was subsequently confirmed by serological test and/or molecular analysis. Serum total LD and LD isoenzyme activities, complete blood picture with total leucocyte count and differential counts, absolute counts of CD3+, CD4+, CD8+, natural killer cells and B lymphocytes were measured daily upon admission. Receiver operating characteristic curve analysis was used to determine and compare different cut-offs for various biochemical and immunological parameters at peak serum total LD concentration in predicting adverse clinical outcomes. RESULTS: Of a total of 109 patients, 41 were admitted to ICU and 42 died. Of 42 fatal patients, 24 died in ICU and 18 died in general medical wards. Age was found to be an independent prognostic indicator for death with an area under curve (AUC) of 0.96 [95% confidence interval (CI) = 0.90-0.99] but not for admission to ICU [AUC = 0.61 (CI = 0.51-0.70)]. Whilst serum total LD could only achieve AUC of 0.68 (CI = 0.59-0.77) for predicting death, LD1 isoenzyme was found to be the best biochemical prognostic indicator with AUC of 0.84 (CI = 0.75-0.90), sensitivity of 62% (CI = 46-76%), specificity of 93% (CI = 83-98%) at cut-off activity of > or =80 U L(-1). CD3+, CD4+, CD8+ and natural killer cell counts were promising immunological prognostic indicators for predicting admission to ICU with AUC of 0.94 (CI = 0.86-0.98), 0.91 (CI = 0.81-0.96), 0.93 (CI = 0.85-0.98), and 0.87 (CI = 0.76-0.94), respectively. CONCLUSIONS: Apart from age, serum LD1 activity was the best prognostic indicator for predicting death in patients with SARS compared with serum total LD activity, haemoglobin concentration, leucocyte and lymphocyte counts. Its release could possibly be from blood erythrocytes and body tissues other than the myocardium. Blood CD3+, CD4+, CD8+ and natural killer cell counts were found to be good prognostic indicators for predicting admission to ICU in patients with SARS compared with age, leucocyte count and LD isoenzymes. The suppressed CD3+, CD4+, CD8+, and natural killer cell counts were also implicated in the pathophysiology of SARS. Patients with increased serum LD1 should be closely monitored to ensure prompt management, and preparation for admission to ICU could be planned ahead for patients with suppressed lymphocyte subsets.

Adult↗
PubMed1995

Tumor angiogenesis in breast cancer: its importance as a prognostic indicator and the association with vascular endothelial growth factor expression.

The importance of tumor angiogenesis in the process of tumor growth and progression in solid tumors has been widely accepted. We have investigated the significance of tumor angiogenesis as a prognostic indicator in a retrospective study including 328 primary breast cancer patients. The postoperative survey demonstrated that the microvessel density (MVD) evaluated by immunocytochemical staining for factor VIII-related antigen is a potent prognostic indicator. The relapse-free survival (RFS) rate of patients with over 100 microvessels/mm2 in a microscopic field was significantly worse compared to that of patients with less than 100 microvessels/mm2 (p < 0.00001). The significance of MVD was found in both node-negative and node-positive patients (p < 0.005 and p < 0.01, respectively). Multivariate analysis confirmed that MVD is an independent prognostic indicator for RFS. In the background factor analysis, MVD was significantly correlated with the number of metastatic nodes (p < 0.01). In addition, the immunocytochemical analysis for vascular endothelial growth factor (VEGF) demonstrated a close association between the increase in MVD and the expression of VEGF (p < 0.001). VEGF status also was a significant prognostic indicator in univariate analysis for RFS (p < 0.01). It was concluded that MVD is a potent prognostic indicator in primary breast cancer. Furthermore, it was also suggested that VEGF plays crucial roles in the promotion of angiogenesis in breast cancer.

Breast Neoplasms↗
PubMed2001

Positive peritoneal cytology in endometrial cancer: enhancement of other prognostic indicators.

OBJECTIVE: The goal of this study was to investigate the prognostic significance of positive peritoneal cytology in endometrial cancer. METHODS: A clinicocytopathological study was performed in 534 patients with endometrial cancer to assess the prognostic value of positive peritoneal cytology. The study population was divided into three groups: a low-risk group (disease limited to the uterus, grade 1, and depth of invasion < or =1/2), a moderate-risk group (disease limited to the uterus, grade 2 or 3, and/or depth of invasion >1/2), and a high-risk group (extrauterine disease). In each group, disease-free survival was compared in the patients who were positive or negative for malignant cells. RESULTS: The overall incidence of positive peritoneal cytology was 22.3% (119/534). The 5-year disease-free survival of patients positive or negative for malignant cells was 98.1% versus 100% in the low-risk group (n = 250), 77.5% versus 91.3% in the moderate-risk group (n = 211), and 42.9% versus 72.1% in the high-risk group (n = 73). A significant difference was noted in the moderate-risk (P = 0.044) and high-risk (P = 0.015) groups, but not in the low-risk group (P = 0.56). CONCLUSIONS: Positive peritoneal cytology is not a negative prognostic indicator itself, but it potentiates other prognostic indicators for endometrial cancer. Our findings also suggest that patients with positive peritoneal cytology in the absence of other adverse prognostic factors do not need upstaging.

Adult↗
PubMed1996

Microvessel density is a prognostic indicator for patients with astroglial brain tumors.

BACKGROUND: Microvessel density in tumors, a measure of angiogenesis, has been shown to be a prognostic indicator that correlates with an increased risk of metastasis in various epithelial cancers and with overall and relapse free survival in patients with breast cancer. Astrocytic brain tumors, particularly malignant astrocytomas, are recognized to be highly vascular tumors with potent angiogenic activity. However, the prognostic significance of microvessel density in these tumors is not known. METHODS: Sections from formalin fixed paraffin embedded tumor tissue from 93 unselected adult patients with supratentorial astrocytic brain tumors were immunostained for factor VIII-related antigen in order to highlight microvessel endothelial cells. Microvessels were counted at 200x and 400x magnification. Microvessel density was graded as 1+ to 4+ on 1 low power field, without knowledge of clinical outcome. Microvessel count and microvessel grade were correlated with postoperative survival using the Cox proportional hazards regression model. The prognostic significance of microvessel count and grade were also compared with established prognostic indicators, including patient age, Karnofsky performance status, and tumor histology using multivariate analyses. RESULTS: Both microvessel grade and microvessel count correlated significantly with postoperative survival by univariate analysis in both previously untreated and treated patients. Patients with tumors containing a microvessel Grade of 3+ or 4+ had significantly shorter survival time than patients with a microvessel Grade of 1+ or 2+ (P = 0.0022). Likewise, patients with microvessel counts of 70 or greater had significantly shorter survival than those with microvessel counts of fewer than 70 (P = 0.041). Patient age, Karnofsky performance status, tumor histology, and extent of resection were also correlated with survival by univariate analysis. Microvessel count was further shown to be an independent prognostic indicator by multivariate analyses. There were correlations between microvessel density and patient age and between microvessel density and astrocytic tumor grade. CONCLUSIONS: These findings support the importance of microvessel density as a prognostic indicator of postoperative survival of patients with astroglial brain tumors. Regional tumor heterogeneity may limit the use of these techniques for routine pathologic examination.

Adult↗
PubMed1993

Postoperative prognostic indicators following trabeculectomy.

We evaluated prognostic indicators for long-term filtration from the ocular examination within the first three months following primary trabeculectomy without antimetabolite therapy. We found that in patients who were more easily controlled at one year postoperatively (intraocular pressure < or = 16 mmHg and using 0-2 medications), compared to those who were more difficult to control (> 16 mmHg or on three medications), the intraocular pressure became significantly different between groups at three months and the number of glaucoma medications at eight weeks postoperatively. More easily controlled patients had greater bleb elevation by one month and extent of bleb formation at two weeks postoperatively. The presence of microcysts, anterior chamber depth, and avascularity did not differ between the two groups. This study suggests that differences in the ocular examination exist within the first three months following trabeculectomy which reflect the postoperative intraocular pressure control at one year.

Aged↗
PubMed1991

Early postoperative prognostic indicators following trabeculectomy.

We compared prognostic indicators manifesting within the first 2 postoperative days, with filtration status 3 months following trabeculectomy in 51 primary open-angle glaucoma patients. Patients with an avascular area in the filtering bleb 2 days after surgery had a significantly lower (P less than .05) intraocular pressure (IOP) (12.6 mm Hg) 3 months postoperatively than patients with vascular blebs (16.3 mm Hg). However, neither the height, breadth, or transparency of the filtering bleb, presence of microcysts, anterior chamber depth, nor IOP during the first 2 postoperative days were related significantly to the filtration status at 3 months.

Female↗
PubMed1993

Tumor angiogenesis is an independent prognostic indicator in primary breast carcinoma.

Clinical importance of tumor angiogenesis, especially its significance as a prognostic indicator, was examined in 125 primary breast-cancer patients. The grade of neovascularization was assessed by the vessel density which was obtained by immunocytochemical staining for factor VIII antigen. Post-operative survey demonstrated that the vessel density is a statistically significant predictor of relapse-free survival (median follow-up period: 62 months). Patients with over 100 counts of factor-VIII antigen-positive cells per 200 x field in the most active areas of neovascularization showed significantly poorer prognosis than those with less than 100 counts. The prognostic value of the vessel density was also confirmed by another evaluation method using immunocytochemical staining to CD-31 which is a platelet/endothelial cell adhesion molecule. A significant difference in relapse-free survival rate was shown between patients having higher counts of CD-31 positive cells and those having lower counts. Breakdown analysis stratified by nodal status showed that the vessel density was a significant prognostic indicator in node-negative and node-positive patients. Multivariate analysis indicated that the vessel density is an independent prognostic indicator in primary breast-cancer patients.

Antigens, Differentiation, Myelomonocytic↗
PubMedDate not supplied

Survival and prognostic indicators in patients with hepatitis B virus-related cirrhosis after onset of hepatic decompensation.

GOALS: To determine the 2-year survival and prognostic indicators of hepatitis B virus-related cirrhosis after the onset of hepatic decompensation. BACKGROUND: Chronic hepatitis B (CHB) patients with cirrhosis and resultant hepatic decompensation have reduced survival. However, the natural history of these patients has not been well characterized in previous studies. Better understanding of survival and prognostic indicators is essential in management of these patients, especially in determining who should be candidates for orthotopic liver transplantation. STUDY: This is a retrospective longitudinal study of 96 patients with CHB-related cirrhosis after the onset of hepatic decompensation. The overall survival was ascertained, and clinical and laboratory variables were analyzed. Significant prognostic indicators for survival at 2 years were determined using univariate and multivariate analyses with Cox regression model. RESULTS: The overall survival was 80% at 2 years after onset of decompensation. With univariate and multivariate analyses, hepatic encephalopathy and hypoalbuminemia less than 2.8 g/dL were significant prognostic indicators of poor survival probability. The hazard ratios were 5.22 (95% confidence interval, 1.67-16.3) and 8.57 (95% confidence interval, 1.94-37.8), respectively. Patients with hypoalbuminemia less than 2.8 g/dL had a 2-year survival of only 62%. CONCLUSIONS: Our study showed that of CHB patients who developed the first episode of hepatic decompensation, those with hepatic encephalopathy or significant hypoalbuminemia or both have worse prognoses. They should be considered potential candidates for liver transplantation.

Female↗
PubMed1996

[Prognostic indicators in patients with liver cirrhosis admitted to an intensive care unit].

OBJECTIVES: Assessment of prognosis in patients with cirrhosis admitted to an Intensive Care Unit remains unsatisfactory. The aims of this retrospective study were to determine the survival rates of patients admitted to an Intensive Care Unit, and to identify and validate prognostic indicators associated with a high mortality rate. METHODS: Two hundred and forty three patients with cirrhosis consecutively admitted to the Intensive Care Unit were studied. The main reasons for admission were upper gastrointestinal bleeding (n = 163), coma (n = 43), sepsis (n = 18), and liver failure (n = 13). Patients were divided into two groups: group 1 (n = 121) to identify prognostic indicators associated with a high mortality rate, and group 2 (n = 122) to validate these indicators. RESULTS: Intensive Care Unit and one year survival rates of patients with cirrhosis admitted for upper gastrointestinal hemorrhage were 76 and 50% respectively. These rates were 40 and 8% respectively for patients admitted for other reasons. In group 1, 4 predictive factors found at admission were identified to have independent significance by stepwise logistic regression: grade III or IV encephalopathy, prothrombin index, serum creatinine, and hypoxemia. On the other hand, the presence of shock on admission was associated with a 100% mortality rate. Two prognostic indicators were defined: shock requiring the administration of vasoactive drugs, and the presence of 3 out of the 4 following predictive factors: grade III or IV encephalopathy, mechanical ventilation, prothrombin index < 30%, and serum creatinine > 130 mumol/L. In group 2, the presence of at least one prognostic indicator at admission or during intensive care was associated with a 96% mortality rate. These indicators were present in 69% of patients who died. In 17 patients who died, but survived more than 24 hours in the Intensive Care Unit, indicators were present an average of 6.0 +/- 5.3 days before death. CONCLUSION: Common prognostic indicators may accurately predict death in patients with cirrhosis admitted to an Intensive Care Unit. These indicators could be helpful in identifying patients who will not benefit from intensive care.

Adult↗
PubMed1996

[The importance of tumor angiogenesis as a prognostic indicator in primary breast cancer].

Recently, the importance of tumor angiogenesis in the process of tumor growth, progression and metastasis in solid tumors has been widely accepted. The prognostic value of angiogenesis has been demonstrated in a variety of solid tumors including breast cancer. In this report, we reviewed recent studies investigating on the value of intratumoral microvessel density (MVD), assessed by a sermiquantitative immunohistochemical assay with using factor-VIII related antibody or anti CD-31 antibody, as a prognostic indicator in primary breast cancer patients. Studies using factor-VIII related antibody showed that the average MVD ranged from 67.3 to 84.0 counts per mm2 area. When used by anti CD-31 monoclonal antibody, the average MVD were 120.3 approximately 135 counts per mm2 area in the range. More than 8 clinical investigations have showed that MVD was a potent prognostic indicator for relapse free survival and/or overall survival in both node-negative and -positive patients. Two reports concluded no prognostic value of MVD, however the average MVD of these two studies significantly differed from other reports. Thus, at present, angiogenesis grade seems to provide an independent prognostic value when the MVD was properly assessed. With respect to the relationship with conventional prognostic indicators, several reports showed the tendency that increased MVD was correlated with younger age and increase of tumor size below 3 cm diameter, however, some reports failed to demonstrate the tendency, suggesting that these correlations are still in controversial. Biological markers including ER, p53 and c-erB2 showed no correlation with the MVD in many studies including our investigation. Only a significant correlation we found was that MVD was increased in tumors with the expression of vascular endothelial growth factor and platelet-derived endothelial cell growth factor, which are noted to be potent endothelial growth factor. Since the evaluation of tumor angiogenesis as a prognostic indicator is now widely investigated in a prospective study, MVD might be introduced to the category of the criteria for determining the schedule of postoperative adjuvant therapy of breast cancer.

Age Factors↗
PubMed1998

[Is there a prognostic indication for PTCA?].

Coronary angioplasty is classically indicated to remove a high grade stenosis of a major coronary vessel supplying a large myocardial territory in a symptomatic patient with proven myocardial ischemia. The coronary anatomy has to be suitable for PTCA to ensure a high success rate for the procedure. PTCA is performed to remove symptoms and myocardial ischemia to improve the prognosis of the patient. In contrast to this, the term "prognostic indication" describes an interventional approach to an angiographically documented high grade stenosis in an asymptomatic patient without proven myocardial ischemia thereby hoping to improve the prognosis of this patient. It has to be expected, that up to 20% of all patients treated by balloon angioplasty and 10% of all stented patients are treated with respect to a "prognostic indication". Until now, there are no statistically significant large-scale studies supporting a benefit of an interventional therapy performed with a "prognostic indication" in asymptomatic patients without ischemia. Nevertheless, some certain subgroups of patients may be candidates for a "prognostic indication" to angioplasty compared to the results of medical therapy. In patients treated interventionally for a "prognostic indication" the acute and long-term individual risk of the underlying coronary disease must be carefully weighted against the risk of the interventional procedure.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

A new prognostic indicator for head and neck cancer--p53 serum antibodies?

BACKGROUND: p53 antibodies are a new serological parameter of unknown potential in patients with malignancies. Their occurrence has been described in various types of cancer patients and several studies in head and neck cancer patients and other cancer patient groups have indicated its prognostic value. MATERIAL AND METHODS: We investigated the incidence of p53 serum antibodies in 271 head and neck cancer patients with an ELISA and investigated a possible correlation with clinical parameters like tumor staging and grading. RESULTS: Sixty-seven head and neck cancer patients (24.7%) were seropositive for p53 antibodies. No correlation between p53 antibody status, tumor staging and grading was found. CONCLUSIONS: These results indicate that the occurrence of p53 antibodies does not correlate with the most relevant prognostic factors, rate of regional metastasis and primary tumor size, in patients with head and neck cancer.

Autoantibodies↗
PubMed1981

Prognostic indicators of ultimate long-term survival following advanced life support.

In an attempt to establish prognostic indicators for ultimate long-term survival following advanced life support (ALS), a two-year (1978-79) retrospective study was made of 92 survivors. The survivors were divided into two groups: the first survived admission to the intensive care unit, but subsequently died in the hospital; the second survived to ultimate discharge from the hospital. The groups were compared for sex, age, basic and advanced provider response time, scene an transport time, witnessed versus unwitnessed arrest, traumatic versus medical arrest, type of airway, presence of aspiration, initial cardiac rhythms, post-arrest vital signs, number of defibrillations, post-arrest ECG changes, essential and useful drugs used, and duration of basic and advanced life support. Of all prognostic indicators studied, duration of ALS correlated most closely with ultimate survival. This article advances the definition of ultimate survival of ALS to mean discharge of the patient from the hospital, and advocates this as the most objective evaluation of successful ALS. The article furthermore offers duration of ALS as an effective prognostic indicator of a patient's chance for ultimate survival.

Critical Care↗
PubMed1996

Markov texture parameters as prognostic indicators in endometrial cancer.

BACKGROUND: Texture is a descriptive property of a surface distinct from color and shape. Image analysis allows gray-scale images to have their optical texture measured and analyzed. The authors, utilizing image analysis, prospectively studied Markov texture parameters to determine their relevance as prognostic indicators of disease recurrence in endometrial cancer. METHODS: Seventy-four consecutive patients, surgically treated, with endometrial cancer, were evaluated for their DNA index (DI), time to recurrence, peritoneal cytology, depth of invasion, lymphovascular space invasion, FIGO stage, grade, histology, as well as 21 Markov parameters. DI and the Markov parameters were quantified using image analysis. RESULTS: Median follow-up for the study population was 31 months with a range from 1 to 44 months. Fifteen patients had recurrence of their cancer and 12 patients died from disease during the observation period of the study. Eleven Markov parameters showed significant correlation with increasing FIGO stage (P < 0.05), while 14 Markov parameters showed significant correlation with survival (P < 0.05). Three Markov parameters, difference entropy (P = 0.025), information measure B (P = 0.01), and diagonal moment (P = 0.046), were demonstrated to be independent prognostic indicators along with the more traditional prognostic indicators, stage (P = 0.006), grade (P = 0.029), and depth of myometrial invasion (P = 0.03). CONCLUSION: Image analysis is able to quantify optical texture. Utilizing bivariate correlations and multivariate analysis, three of these parameters were demonstrated to be independent prognostic indicators in endometrial cancer, specifically difference entropy, information measure B, and diagonal moment.

Adult↗
PubMed1987

Prognostic indicators in acute variceal hemorrhage after treatment by schlerotherapy.

The purpose of the study was to evaluate prognostic indicators in patients receiving endoscopic injection sclerosis for bleeding esophageal varices. The results below were obtained from a prospective nonrandomized study in which the patients were subdivided into the following groups (subsets): elective sclerotherapy--10, active variceal bleeding at endoscopy--47, active variceal bleeding with spontaneous resolution at the time of endoscopy--21, and gastric variceal bleeding--nine. The data were analyzed as follows: 14 variables possibly affecting 6-wk survival were evaluated by stepwise logistic regression analysis. Variables examined were subset, age, sex, Child's classification, ascites, comorbid conditions, SGOT, bilirubin, protime, albumin, volume of initial bleed, volume of rebleed, rebleed rate, and Blakemore tube use. Survival curves were also compared using the Kaplan-Meier methodology. The following results were obtained. First, the subsets above had significantly different survival curve patterns with the elective endoscopic injection sclerosis group having the best prognosis and the gastric variceal bleeders a significantly poorer survival. Second, stepwise logistic regression analysis revealed the following four significant variable prognostic indicators: comorbid factors, subset, Child's classification, and serum albumin. Although the latter two variables, Child's class (p = 0.03) and albumin (p = 0.1) had an impact on six week survival, this was no longer seen when subset (p = 0.0124) and comorbid factors (p = 0.003) were taken into account. We conclude that comorbid factors and subsets of variceal bleeding in themselves were the only two prognostic indicators showing a statistically significant association with 6-wk and long-term survival. In contrast, the more usual clinical prognostic parameters, i.e., the physical findings and biochemical test of liver function in patients with cirrhosis and acute variceal bleeding, were of lesser prognostic magnitude.

Acute Disease↗
PubMed1980

Five years' experience with intraaortic balloon pumping. The changing of indications and the emergence of prognostic indices.

The authors report their experience with IABP during 5 years. 40 patients have been submitted to this procedure, 31 for spontaneous non-complicated myocardial infarction. Overall survival rate was poor in those non-surgical conditions (8/31); better outcome was obtained if IABP was applied earlier in the course of the infarction and if left ventricular filling was continuously assessed. Therefore, use of prognostic index (such as SWI/PWP) and monitoring of pulmonary wedge pressure is stressed. Incidence of sudden death is high among short term survivors 4 out 5 deaths in 8 short term survivors. Usefulness of IABP in preparation for surgery or/and as postsurgical support is evident in this series (5/7 successes) with the exception of patients who did not come off pump (2 cases) and for whom IABP was ineffective.

Assisted Circulation↗
PubMed1991

Prognostic indicators and risk factors for increased duration of acute diarrhoea and for persistent diarrhoea in children.

To identify the prognostic indicators and risk factors for increased duration of acute diarrhoea and for occurrence of persistent diarrhoea (i.e. acute episodes lasting longer than 14 days) in children under three years, a systematic sample (3690) of patients attending a large treatment centre in Bangladesh was analysed using multiple regression, logistic regression and stratified (Mantel-Haenszel) analysis. Significant prognostic indicators or risk factors for increase in duration of acute diarrhoea, after adjusting for confounders, include bloody or mucoid diarrhoea, concomitant signs of chest infection, presence of vitamin A deficiency signs, decreased weight for age, routine use of contaminated surface water, lack of breastfeeding and increasing age; presence of rotavirus or enterotoxigenic Escherichia coli or Vibrio cholerae 01 in stool had negative association. In logistic regression and stratified analysis these factors, except for lack of breastfeeding and age, were also found to be risk factors or prognostic indicators of persistent diarrhoea. Policy implications of these findings for programmes to reduce morbidity and mortality from persistent diarrhoea include development of effective vaccines against dysentery-causing Shigella, programmes to prevent vitamin A deficiency, protein energy malnutrition and acute respiratory infections in children, and long-term programmes to provide clean water for all day-to-day needs.

Acute Disease↗