A clinical prediction rule for nerve-function impairment in leprosy patients

R P Croft, P G Nicholls, E W Steyerberg, J H Richardus, W C S Smith

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Background: Nerve-function impairment (NFI) commonly occurs during or after chemotherapy in leprosy and is the hey pathological process leading to disability and handicap. We describe the development of a simple clinical prediction rule for estimating the risk of NFI occurrence.

Methods: New leprosy cases who presented to a centre in Bangladesh were recruited and followed up for 2 years in a field setting. We used multivariable regression analysis by Cox's proportional hazards model to identify predictive variables for NFI. Discriminative ability was measured by a concordance statistic. Internal validity was assessed with bootstrap resampling techniques.

Findings: 2510 patients were followed up for 2 years, 166 developed NF. A simple model was developed with leprosy group (either paucibacillary leprosy [PB] or multibacillary leprosy [MB]) and the presence of any nerve-function loss at registration as predictive variables. Patients with PB leprosy and no nerve-function loss had a 1.3% (95% CI 0.8-1.8%) risk of developing NFI within 2 years of registration; patients with PB leprosy and nerve-function loss, or patients with MB leprosy and no nerve-function loss had a 16.0% (12-20%) risk; and patients with MB leprosy with nerve-function loss had a 65% (56-73%) risk.

Interpretation: Our prediction rule can be used to plan surveillance of new leprosy patients. Patients at low risk of NFI may need no follow-up beyond their course of chemotherapy (6 months); patients with intermediate risk need a minimum of 1 year of surveillance; and patients with high risk should have at least 2 years of surveillance for new NFI. Current recommendations for surveillance of patients with leprosy (for the duration of chemotherapy only) exclude an important group of patients who are at risk of developing NFI after completion of treatment.

Original languageEnglish
Pages (from-to)1603-1606
Number of pages4
JournalThe Lancet
Volume355
Publication statusPublished - 2000

Keywords

  • TYPE-1 REACTIONS
  • CONTROL PROGRAM
  • RISK-FACTORS
  • WEST NEPAL
  • DAMAGE
  • EXPERIENCE
  • MANAGEMENT
  • REGIMEN
  • MODELS

Cite this

Croft, R. P., Nicholls, P. G., Steyerberg, E. W., Richardus, J. H., & Smith, W. C. S. (2000). A clinical prediction rule for nerve-function impairment in leprosy patients. The Lancet, 355, 1603-1606.

A clinical prediction rule for nerve-function impairment in leprosy patients. / Croft, R P ; Nicholls, P G ; Steyerberg, E W ; Richardus, J H ; Smith, W C S .

In: The Lancet, Vol. 355, 2000, p. 1603-1606.

Research output: Contribution to journalArticle

Croft, RP, Nicholls, PG, Steyerberg, EW, Richardus, JH & Smith, WCS 2000, 'A clinical prediction rule for nerve-function impairment in leprosy patients', The Lancet, vol. 355, pp. 1603-1606.
Croft RP, Nicholls PG, Steyerberg EW, Richardus JH, Smith WCS. A clinical prediction rule for nerve-function impairment in leprosy patients. The Lancet. 2000;355:1603-1606.
Croft, R P ; Nicholls, P G ; Steyerberg, E W ; Richardus, J H ; Smith, W C S . / A clinical prediction rule for nerve-function impairment in leprosy patients. In: The Lancet. 2000 ; Vol. 355. pp. 1603-1606.
@article{7d8697168dc64d9dbea7b22ee272fa59,
title = "A clinical prediction rule for nerve-function impairment in leprosy patients",
abstract = "Background: Nerve-function impairment (NFI) commonly occurs during or after chemotherapy in leprosy and is the hey pathological process leading to disability and handicap. We describe the development of a simple clinical prediction rule for estimating the risk of NFI occurrence.Methods: New leprosy cases who presented to a centre in Bangladesh were recruited and followed up for 2 years in a field setting. We used multivariable regression analysis by Cox's proportional hazards model to identify predictive variables for NFI. Discriminative ability was measured by a concordance statistic. Internal validity was assessed with bootstrap resampling techniques.Findings: 2510 patients were followed up for 2 years, 166 developed NF. A simple model was developed with leprosy group (either paucibacillary leprosy [PB] or multibacillary leprosy [MB]) and the presence of any nerve-function loss at registration as predictive variables. Patients with PB leprosy and no nerve-function loss had a 1.3{\%} (95{\%} CI 0.8-1.8{\%}) risk of developing NFI within 2 years of registration; patients with PB leprosy and nerve-function loss, or patients with MB leprosy and no nerve-function loss had a 16.0{\%} (12-20{\%}) risk; and patients with MB leprosy with nerve-function loss had a 65{\%} (56-73{\%}) risk.Interpretation: Our prediction rule can be used to plan surveillance of new leprosy patients. Patients at low risk of NFI may need no follow-up beyond their course of chemotherapy (6 months); patients with intermediate risk need a minimum of 1 year of surveillance; and patients with high risk should have at least 2 years of surveillance for new NFI. Current recommendations for surveillance of patients with leprosy (for the duration of chemotherapy only) exclude an important group of patients who are at risk of developing NFI after completion of treatment.",
keywords = "TYPE-1 REACTIONS, CONTROL PROGRAM, RISK-FACTORS, WEST NEPAL, DAMAGE, EXPERIENCE, MANAGEMENT, REGIMEN, MODELS",
author = "Croft, {R P} and Nicholls, {P G} and Steyerberg, {E W} and Richardus, {J H} and Smith, {W C S}",
year = "2000",
language = "English",
volume = "355",
pages = "1603--1606",
journal = "The Lancet",
issn = "0140-6736",
publisher = "ACADEMIC PRESS INC ELSEVIER SCIENCE",

}

TY - JOUR

T1 - A clinical prediction rule for nerve-function impairment in leprosy patients

AU - Croft, R P

AU - Nicholls, P G

AU - Steyerberg, E W

AU - Richardus, J H

AU - Smith, W C S

PY - 2000

Y1 - 2000

N2 - Background: Nerve-function impairment (NFI) commonly occurs during or after chemotherapy in leprosy and is the hey pathological process leading to disability and handicap. We describe the development of a simple clinical prediction rule for estimating the risk of NFI occurrence.Methods: New leprosy cases who presented to a centre in Bangladesh were recruited and followed up for 2 years in a field setting. We used multivariable regression analysis by Cox's proportional hazards model to identify predictive variables for NFI. Discriminative ability was measured by a concordance statistic. Internal validity was assessed with bootstrap resampling techniques.Findings: 2510 patients were followed up for 2 years, 166 developed NF. A simple model was developed with leprosy group (either paucibacillary leprosy [PB] or multibacillary leprosy [MB]) and the presence of any nerve-function loss at registration as predictive variables. Patients with PB leprosy and no nerve-function loss had a 1.3% (95% CI 0.8-1.8%) risk of developing NFI within 2 years of registration; patients with PB leprosy and nerve-function loss, or patients with MB leprosy and no nerve-function loss had a 16.0% (12-20%) risk; and patients with MB leprosy with nerve-function loss had a 65% (56-73%) risk.Interpretation: Our prediction rule can be used to plan surveillance of new leprosy patients. Patients at low risk of NFI may need no follow-up beyond their course of chemotherapy (6 months); patients with intermediate risk need a minimum of 1 year of surveillance; and patients with high risk should have at least 2 years of surveillance for new NFI. Current recommendations for surveillance of patients with leprosy (for the duration of chemotherapy only) exclude an important group of patients who are at risk of developing NFI after completion of treatment.

AB - Background: Nerve-function impairment (NFI) commonly occurs during or after chemotherapy in leprosy and is the hey pathological process leading to disability and handicap. We describe the development of a simple clinical prediction rule for estimating the risk of NFI occurrence.Methods: New leprosy cases who presented to a centre in Bangladesh were recruited and followed up for 2 years in a field setting. We used multivariable regression analysis by Cox's proportional hazards model to identify predictive variables for NFI. Discriminative ability was measured by a concordance statistic. Internal validity was assessed with bootstrap resampling techniques.Findings: 2510 patients were followed up for 2 years, 166 developed NF. A simple model was developed with leprosy group (either paucibacillary leprosy [PB] or multibacillary leprosy [MB]) and the presence of any nerve-function loss at registration as predictive variables. Patients with PB leprosy and no nerve-function loss had a 1.3% (95% CI 0.8-1.8%) risk of developing NFI within 2 years of registration; patients with PB leprosy and nerve-function loss, or patients with MB leprosy and no nerve-function loss had a 16.0% (12-20%) risk; and patients with MB leprosy with nerve-function loss had a 65% (56-73%) risk.Interpretation: Our prediction rule can be used to plan surveillance of new leprosy patients. Patients at low risk of NFI may need no follow-up beyond their course of chemotherapy (6 months); patients with intermediate risk need a minimum of 1 year of surveillance; and patients with high risk should have at least 2 years of surveillance for new NFI. Current recommendations for surveillance of patients with leprosy (for the duration of chemotherapy only) exclude an important group of patients who are at risk of developing NFI after completion of treatment.

KW - TYPE-1 REACTIONS

KW - CONTROL PROGRAM

KW - RISK-FACTORS

KW - WEST NEPAL

KW - DAMAGE

KW - EXPERIENCE

KW - MANAGEMENT

KW - REGIMEN

KW - MODELS

M3 - Article

VL - 355

SP - 1603

EP - 1606

JO - The Lancet

JF - The Lancet

SN - 0140-6736

ER -