Retraso en el diagnóstico de lepra como factor pronóstico de discapacidad en una cohorte de pacientes en Colombia, 2000-2010

Abstract

Objective. Evaluate predictive factors of disability at time of leprosy diagnosis in a cohort of Colombian patients, from 2000 to 2010. Methods. Descriptive and analytical observational study of a retrospective cohort of patients admitted with a leprosy diagnosis to the Centro Dermatológico Federico Lleras Acosta in Bogotá, Colombia, from 2000 to 2010. Variables were analyzed descriptively and predictive factors for disability at diagnosis were identified through simple and multifactorial analyses (Cox proportional hazards model); hazard ratios for each factor in the model were calculated. Results. Time between first symptoms and diagnosis in the 333 cohort patients was 2.9 years on average; 32.3% had certain degree of disability, especially for the feet. Delay in diagnosis and disability was greater in men than in women and in patients with multibacillary rather than paucibacillary leprosy. Disability was significantly associated with delays of ≥ 1 year in diagnosis, age ≥ 30 years, initial bacillary index of ≥ 2, multibacillary leprosy, and natives of the Cundinamarca or Santander departments. Protective factors were female sex, having some education, and residence in Boyacá. Conclusions. Time between first symptoms and diagnosis is the key predictive factor of disability at time of leprosy diagnosis. Strengthening of active searching for infected people and promotion of early diagnosis are recommended.