Screening for Chikungunya virus infection in aged people: Development and internal validation of a new score

Abstract

Background This study aimed to derive and validate a score for Chikungunya virus (CHIKV) infection screening in old people admitted to acute care units. Methods This study was performed in the Martinique University Hospitals from retrospective cases. Patients were aged 65+, admitted to acute care units for suspected CHIKV infection in 2014, with biological testing using Reverse Transcription Polymerase Chain Reaction (RT-PCR). RT-PCR was used as the gold standard. A screening score was created using adjusted odds ratios of factors associated with positive RT-PCR derived from a multivariable logistic regression model. A ROC curve was used to determine the best cut-off of the score. Bootstrap analysis was used to evaluate its internal validity. Results In all, 687 patients were included, 68% with confirmed CHIKV infection, and 32% with laboratory-unconfirmed CHIKV infection. Mean age was 80±8 years, 51% were women. Four variables were found to be independently associated with positive RT-PCR (fever: 3 points; arthralgia of the ankle: 2 points; lymphopenia: 6 points; absence of neutrophil leucocytosis: 10 points). The best cut-off was score 12; sensitivity was 87% (83%-90%) and specificity was 70% (63%-76%). Conclusion This score shows good diagnostic performance and good internal validation and could be helpful to screen aged people for CHIKV infection.