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de Moraes L, Cerqueira-Silva T, Nobrega V, Akrami K, Santos LA, Orge C, Casais P, Cambui L, Rampazzo RDCP, Trinta KS, Montalbano CA, Teixeira MJ, Cavalcante LP, Andrade BB, da Cunha RV, Krieger MA, Barral-Netto M, Barral A, Khouri R, Boaventura VS. A clinical scoring system to predict long-term arthralgia in Chikungunya disease: A cohort study. PLoS Negl Trop Dis 2020; 14:e0008467. [PMID: 32693402 PMCID: PMC7373495 DOI: 10.1371/journal.pntd.0008467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) has caused worldwide epidemics that impose a major burden on health systems. Approximately half of infected individuals develop chronic debilitating arthralgia, affecting their quality of life. Here, we identified the relevant clinical and demographic variables in the acute phase of CHIKV infection prospectively linked to chronic arthralgia to elaborate a prognostic scoring system. METHODS Acute CHIKV infection cases (n = 134) confirmed by serology or molecular test were examined <10 days of disease onset and followed for one year to evaluate for disease progression. Potential risk factors for chronic arthralgia were evaluated by multivariate analysis to develop a prognostic scoring system, which was subsequently tested in an independent validation cohort consisting of 42 individuals. RESULTS A total of 107 out of 134 (80%) acute CHIKV-confirmed cases from the derivation cohort were re-examined one year after enrollment. Chronic arthralgia post-CHIKV infection was diagnosed in 64 (60%). Five of the 12 parameters evaluated in the acute phase were statistically associated with persistent arthralgia and were further tested by Bayesian analysis. These variables were weighted to yield a prognosis score denominated SHERA (Sex, Hypertension, Edema, Retroocular pain, Age), which exhibited 81.3% accuracy in predicting long-term arthralgia post-CHIKV infection in the derivation cohort, and 76.5% accuracy in the validation cohort. CONCLUSIONS The simplified and externally validated prognostic scoring system, SHERA, is a useful method to screen acutely CHIKV-infected patients at elevated risk of chronic arthralgia who will benefit from specific interventions. This tool could guide public health policies, particularly in resource-constrained settings.
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Affiliation(s)
- Laise de Moraes
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Victor Nobrega
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Kevan Akrami
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- University of California, San Diego, Division of Infectious Disease, Department of Medi- cine, San Diego, California, United States of America
| | | | - Cibele Orge
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Paula Casais
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Lais Cambui
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | | | | | | | | | | | - Bruno B. Andrade
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
| | - Rivaldo Venâncio da Cunha
- Faculdade de Medicina, Universidade do Mato Grosso do Sul, Campo Grande- MS, Brazil
- Fiocruz, Campo Grande, MS, Brazil
| | - Marco Aurélio Krieger
- Instituto de Biologia Molecular do Paraná, Curitiba, PR, Brasil
- Instituto Carlos Chagas—ICC/Fiocruz, Curitiba-PR, Brazil
| | - Manoel Barral-Netto
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo- SP, Brazil
| | - Aldina Barral
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo- SP, Brazil
| | - Ricardo Khouri
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Viviane Sampaio Boaventura
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Serviço de Otorrinolaringologia do Hospital Santa Izabel/Santa Casa de Misericórdia da Bahia (HIS/SCMBa), Salvador, Brazil
- * E-mail:
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