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Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot (‘BA-TOF’ Score): Results of a Case–Control Study and Implications for Community Surveillance

Kanneganti, Vidyasagar ; Thakar, Sumit ; Aryan, Saritha ; Kini, Prayaag ; Mohan, Dilip ; Hegde, Alangar S.

Journal of neurosciences in rural practice, 2021-04, Vol.12 (2), p.302-307, Article 302 [Periódico revisado por pares]

A-12, 2nd Floor, Sector 2, Noida-201301 UP, India: Thieme Medical and Scientific Publishers Pvt. Ltd

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  • Título:
    Clinical and Laboratory Markers of Brain Abscess in Tetralogy of Fallot (‘BA-TOF’ Score): Results of a Case–Control Study and Implications for Community Surveillance
  • Autor: Kanneganti, Vidyasagar ; Thakar, Sumit ; Aryan, Saritha ; Kini, Prayaag ; Mohan, Dilip ; Hegde, Alangar S.
  • Assuntos: Original ; Original Article
  • É parte de: Journal of neurosciences in rural practice, 2021-04, Vol.12 (2), p.302-307, Article 302
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: Abstract Background  Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF). Methods  From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case–control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA. Statistical Analysis  Variables demonstrating significant bivariate correlations with the presence of a CBA were further analyzed using multivariate logistic regression (LR) analysis. Various LR models were tested for their predictive value, and the best model was then validated on a hold-out dataset of 25 patients. Results  Among the 26 variables tested for bivariate associations with the presence of a CBA, some of the clinical, echocardiographic, and laboratory variables demonstrated significant correlations ( p < 0.05). LR analysis revealed elevated neutrophil–lymphocyte ratio and erythrocyte sedimentation rate values and a lower age-adjusted resting heart rate percentile to be the strongest independent biomarkers of a CBA. The LR model was statistically significant, (χ 2 = 23.72, p = <0.001), and it fitted the data well. It explained 53% (Nagelkerke R 2 ) of the variance in occurrence of a CBA, and correctly classified 83.93% of cases. The model demonstrated a good predictive value (area under the curve: 0.80) on validation analysis. Conclusions  This study has identified simple clinical and laboratory parameters that can serve as reliable pointers of a CBA in patients with TOF. A scoring model—the ‘BA-TOF’ score—that predicts the occurrence of a CBA has been proposed. Patients with higher scores on the proposed model should be referred urgently for a CT confirmation of the diagnosis. Usage of such a diagnostic aid in resource-limited settings can optimize the pickup rates of a CBA and potentially improve outcomes.
  • Editor: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India: Thieme Medical and Scientific Publishers Pvt. Ltd
  • Idioma: Inglês
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