Leprosy reactions are immune-mediated complications occurring in up to 50% of patients. The immune consequences of helminth infections and micronutrient deficiencies suggest a potential role in type 1 reactions (T1R) or type 2 reactions (T2R). We conducted a case-control study in Minas Gerais, Brazil, to evaluate whether comorbidities and other factors are associated with reactions in patients with multibacillary leprosy. Stool and serum were tested for helminth infections. Deficiencies of vitamin A, D, and iron were measured using serum retinol, 25-hydroxyvitamin D, and ferritin, respectively. Logistic regression models identified associations between reactions and helminth infections, micronutrient deficiencies, and other variables. Seventy-three patients were enrolled, 24 (33%) with T1R, 21 (29%) with T2R, 8 (15%) with mixed T1R/T2R, and 20 (27%) without reactions. Evidence of helminth infections were found in 11 participants (15%) and included IgG4 reactivity against Schistosoma mansoni, Strongyloides, and Ascaris antigens. Thirty-eight (52%) had vitamin D deficiency, eight (11%) had vitamin A insufficiency, 21 (29%) had anemia, and one (1.4%) had iron deficiency. Multivariable logistic regression showed no statistically significant associations between helminth coinfections and total reactions (adjusted odds ratios [aOR]: 1.36, 95% CI: 0.22, 8.33), T1R (aOR: 0.85, 95% CI: 0.17, 4.17), or T2R (aOR: 2.41, 95% CI: 0.29, 20.0). Vitamin D deficiency and vitamin A insufficiency were also not statistically associated with reactions. However, vitamin deficiencies and helminth infections were prevalent in these patients, suggesting a potential role for additional treatment interventions. Studying reactions prospectively may further clarify the role of comorbidities in the clinical presentation of leprosy.
RESUMOO sistema de Grupos Diagnósticos Relacionados (DRG) permite avaliar o desempenho institucional quanto aos serviços da equipe de saúde. Condições adquiridas (CA) associam-se a complicações das ações dessa equipe. O objetivo do estudo foi analisar estratégias para identificar CAs hospitalares mediante registros do sistema DRG. Adotamos a lista de Hospital Acquired Conditions (HACs) do Centers of Medicare & Medicaid Service (CMS).Comparou-se HACs às CAs identificadas no banco de dados (BD) do sistema DRG institucional, aplicando-se Risco Relativo (RR) e intervalo de confiança de 95%. A concordância entre observações (HACs e CAs) foi analisada através da estatística Kappa. Registros do sistema DRG selecionados aleatoriamente foram classificados quanto à probabilidade para HAC. Registraram-se 550 CAs entre 31.472 participantes (1,7%) e 1.594 HACs (5,0%), sendo 123 eventos (7,7%) comuns em ambas. RR de HACs em comparação às CAs foi 5,4 [IC 95%: 4,5-6,6, valor p < 0,01]. A concordância foi pobre (kappa 0,09, IC 95% 0,07-0,1 e valor p < 0,01). Analisando-se subgrupos de HAC 5 (Diagnóstico secundário de quedas e traumas) e 6 (Diagnóstico secundário de infecção do trato urinário associado a cateter) em 91 internações, classificamos 33 como baixo risco para HAC, 34 como alto risco e 24 como risco indeterminado. Concluímos que a análise do BD Institucional subestima a incidência de CAs, embora o método HACs possa incluir falso-positivos. Recomendamos estudos comparativos com outros modelos de identificação de HACs. Palavras COMPARISON OF STRATEGIES FOR DETECTION OF CONDITIONS ACQUIRED IN A PUBLIC HOSPITAL ACCORDING TO THE SYSTEM OF RELATED DIAGNOSTIC GROUPS (DRG) ABSTRACTThe system of Related Diagnostic Groups (DRG) allows to evaluate the institutional performance regarding the services of the health team. Acquired conditions (AC) are associated with complications of the actions of this team. The objective of the study was to analyze strategies to identify hospital CAs using DRG system records. We have adopted the Centers for Medicare & Medicaid Service (CMS) Hospital Acquired Conditions (HACs) list.HACs were compared to the CAs identified in the database (DB) of the institutional DRG system, applying Relative Risk (RR) and 95% confidence interval. The concordance between observations (HACs and CAs) was analyzed using Kappa statistics. Randomly selected DRG system records were classified as to the probability for HAC. We recorded 550 CAs among 31,472 participants (1.7%) and 1,594 HACs (5.0%), with 123 events (7.7%) common in both. RR of HACs compared to CAs was 5.4 [95% CI: 4.5-6.6, p value <0.01]. The agreement was poor (0.09 kappa, 95% CI 0.07-0.1 and p value <0.01). Analyzing subgroups of HAC 5 (Secondary diagnosis of falls and traumas) and 6 (Secondary diagnosis of catheter-associated urinary tract infection) in 91 hospitalizations, we classified 33 as low risk for HAC, 34 as high risk and 24 as undetermined risk. We conclude that the analysis of Institutional BD underestimates the incidence of CAs, although the ...
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