Fatores de risco para desenvolvimento de incapacidade física em casos novos de hanseníase, notificados em serviço de referência de Belo Horizonte, no período de 2005-2010

Abstract

The objective of the study was to investigate the risk factors for physical disability at release from multi-drug therapy (MDT) in new cases of leprosy, registered at a Referral Centre in the city of Belo Horizonte, Brazil. It is a longitudinal and retrospective study conducted at Eduardo de Menezes Hospital that evaluated 260 patients. Clinical and sociodemographic informations were collected from the medical records. Comparisons were made between the disability grade upon admission and at the end of MDT, using a marginal homogeneity test. To determine factors associated with physical disability at release from treatment, univariate analysis was employed using chi-square test, Fishers exact test or Kruskall Wallis test. Multivariate analysis was performed using ordinal logistic regression and classification and regression tree algorithm. At diagnosis, 21.5% of the patients presented with grade 1 impairment and 16.2% with grade 2. The prevalence of disability did not differ significantly between intake and release from treatment. The risk factors for disability at the end of MDT at multivariate analysis were: number of affected nerves, sensory impairment and, mainly, the presence of disability at diagnosis. The analysis using classification and regression tree algorithm resulted in the development of a clinical rule to predict the risk of disability at release from MDT. Patients with grade 1 disability at intake had a probability of 10.7% of developing grade 2 disability at release from treatment. While 95.2% of the patients with grade 2 disability at diagnosis remained the same at the end of MDT. The results of the study draw attention to the importance of early diagnosis in the prevention of disability.