Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease

American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients a...

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Bibliographic Details
Published in:PLoS neglected tropical diseases 2021-08, Vol.15 (8), p.e0009680
Main Authors: Nunes da Costa, Erika Alessandra Pellison, Victória, Cassiano, Fortaleza, Carlos Magno Castelo Branco
Format: Article
Language:English
Subjects:
Abnormalities
Asymptomatic
Benznidazole
Biology and Life Sciences
Body mass
Body mass index
Body size
Cardiomyopathy
Chagas disease
Cohorts
Complications and side effects
Confidence intervals
Demography
Digestive system diseases
Disorders
Gender
Heart attacks
Heart diseases
Heart failure
Housing conditions
Impact analysis
Malformations
Medicine and Health Sciences
Patients
People and places
Regression analysis
Regression models
Risk factors
Serology
Statistical analysis
Statistical methods
Therapy
Tropical diseases
Trypanosomiasis
Vector-borne diseases
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Summary:American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53–3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11–0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03–2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0009680