PLoS Neglected Tropical Diseases (Jul 2020)

A clinical scoring system to predict long-term arthralgia in Chikungunya disease: A cohort study.

  • Laise de Moraes,
  • Thiago Cerqueira-Silva,
  • Victor Nobrega,
  • Kevan Akrami,
  • Luciane Amorim Santos,
  • Cibele Orge,
  • Paula Casais,
  • Lais Cambui,
  • Rita de Cássia Pontello Rampazzo,
  • Karen Soares Trinta,
  • Camila Amato Montalbano,
  • Maria Jania Teixeira,
  • Luciano Pamplona Cavalcante,
  • Bruno B Andrade,
  • Rivaldo Venâncio da Cunha,
  • Marco Aurélio Krieger,
  • Manoel Barral-Netto,
  • Aldina Barral,
  • Ricardo Khouri,
  • Viviane Sampaio Boaventura

DOI
https://doi.org/10.1371/journal.pntd.0008467
Journal volume & issue
Vol. 14, no. 7
p. e0008467

Abstract

Read online

BackgroundChikungunya 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.MethodsAcute CHIKV infection cases (n = 134) confirmed by serology or molecular test were examined ResultsA 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.ConclusionsThe 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.