A Predictive Model for Thiamine Responsive Disorders Among Infants and Young Children: Results from a Prospective Cohort Study in Lao People's Democratic Republic - 23/04/24
, Charles D. Arnold, MS 1, Philip R. Fischer, MD 2, 3, 4, Indi Trehan, MD, MPH DTM&H 5, 6, Laurent Hiffler, MD 7, Dalaphone Sitthideth, MD 8, Rebecca Stein-Wexler, MD 9, Jay Yeh, MD 10, Kerry S. Jones, PhD 11, Daniela Hampel, PhD 1, 12, Daniel J. Tancredi, PhD 13, Michael A. Schick, DO, MA 14, Christine N. McBeth, DO, MSPH 14, Xiuping Tan, BS 1, Lindsay H. Allen, PhD 1, 12, Somphou Sayasone, MD, PhD 8, Sengchanh Kounnavong, MD, PhD 8, Sonja Y. Hess, PhD 1Abstract |
Objective |
To develop a predictive model for thiamine responsive disorders (TRDs) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDDs) based on response to therapeutic thiamine in a high-risk setting.
Study design |
Children aged 21 days to <18 months hospitalized with signs or symptoms suggestive of TDD in northern Lao People’s Democratic Republic were treated with parenteral thiamine (100 mg daily) for ≥3 days in addition to routine care. Physical examinations and recovery assessments were conducted frequently for 72 hours after thiamine was initiated. Individual case reports were independently reviewed by three pediatricians who assigned a TRD status (TRD or non-TRD), which served as the dependent variable in logistic regression models to identify predictors of TRD. Model performance was quantified by empirical area under the receiver operating characteristic curve.
Results |
A total of 449 children (median [Q1, Q3] 2.9 [1.7, 5.7] months old; 70.3% exclusively/predominantly breastfed) were enrolled; 60.8% had a TRD. Among 52 candidate variables, those most predictive of TRD were exclusive/predominant breastfeeding, hoarse voice/loss of voice, cyanosis, no eye contact, and no diarrhea in the previous 2 weeks. The area under the receiver operating characteristic curve (95% CI) was 0.82 (0.78, 0.86).
Conclusions |
In this study, the majority of children with signs or symptoms of TDD responded favorably to thiamine. While five specific features were predictive of TRD, the high prevalence of TRD suggests that thiamine should be administered to all infants and children presenting with any signs or symptoms consistent with TDD in similar high-risk settings. The usefulness of the predictive model in other contexts warrants further exploration and refinement.
Trial registration |
Clinicaltrials.gov NCT03626337.
Le texte complet de cet article est disponible en PDF.Keywords : beriberi, thiamine deficiency, thiamine deficiency disorders, critical illness, cardiac distress, respiratory distress, encephalopathy, Southeast Asia
Abbreviations : AUROC, ETKac, TDD, ThDP, TRD
Plan
Vol 268
Article 113961- mai 2024 Retour au numéro
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