Table 4.
Characteristics of Shigella Moderate to Severe Diarrhea (MSD) Cases Defined as Culture Positive or Quantitative Polymerase Chain Reaction (qPCR)-Attributable (N = 1481) Who Died Versus Those Who Survived in the 14 Days Post enrollment
| Characteristic | Died (n = 22) | Survived (n = 1459) | Hazard Ratiob (95% CI) | Hazard Ratio (95% CI)c | ||
|---|---|---|---|---|---|---|
| n | (%)a | n | (%)a | |||
| Sociodemographic | ||||||
| Age | ||||||
| 0–5 m | 3 | (13.6) | 32 | (2.2) | 10.7 (2.6–45.0) | 6.3 (1.4–27.5) |
| 6–11 m | 4 | (18.2) | 181 | (12.4) | 2.6 (.7–9.8) | 1.6 (.4–5.8) |
| 12–23 m | 10 | (45.5) | 644 | (44.1) | 1.9 (.6–5.4) | 1.3 (.4–3.8) |
| 24–59 m | 5 | (22.7) | 602 | (41.3) | Ref | Ref |
| Sex | ||||||
| Female | 7 | (31.8%) | 651 | (44.6%) | 0.6 (.2–1.4) | 0.6 (.2–1.4) |
| Male | 15 | (68.2%) | 808 | (55.4%) | Ref | Ref |
| Clinical characteristics | ||||||
| Dysentery | ||||||
| Present | 7 | (31.8%) | 829 | (56.8%) | 0.4 (.2–.9) | 0.6 (.2–1.6) |
| Absent | 15 | (68.2%) | 630 | (43.2%) | Ref | Ref |
| Caregiver reported mucoid stool | ||||||
| Present | 8 | (36.4%) | 575 | (39.4%) | 0.9 (.4–2.1) | 1.2 (.5–3.0) |
| Absent | 14 | (63.6%) | 884 | (60.6%) | Ref | Ref |
| Duration of diarrhea (including day of presentation) | ||||||
| ≥3 | 19 | (86.4%) | 757 | (51.9%) | 5.8 (1.7–19.6) | 4.4 (1.3–15.3) |
| <3 | 3 | (13.6%) | 702 | (48.1%) | Ref | Ref |
| Max no. of loose stools child passed in 24-h period | ||||||
| ≥7 | 7 | (31.8%) | 677 | (46.4%) | 0.5 (.2–1.3) | 1.1 (.4–2.9) |
| <7 | 15 | (68.2%) | 782 | (53.6%) | Ref | Ref |
| Temperature | ||||||
| ≥38°C | 9 | (40.9%) | 349 | (23.9%) | 2.2 (.9–5.1) | 2.1 (.9–5.1) |
| <38°C | 13 | (59.1%) | 1110 | (76.1%) | Ref | Ref |
| Caregiver reported vomiting | ||||||
| >3 times per day | 12 | (54.6%) | 346 | (23.7%) | 3.8 (1.6–8.8) | 2.5 (1.1–5.9) |
| ≤3 times per day (or none) | 10 | (45.5%) | 1113 | (76.3%) | Ref | Ref |
| WHO-defined dehydration categories | ||||||
| Severe | 20 | (90.9%) | 577 | (39.7%) | 17.9 (2.4–133.3) | 7.9 (.8–79.7) |
| Some | 1 | (4.6%) | 356 | (24.4%) | 1.5 (.09–23.6) | 1.3 (.07–23.5) |
| None | 1 | (4.6%) | 526 | (36.1%) | Ref | Ref |
| Chronic malnutrition | ||||||
| Stunted (LAZ <−2) | 11 | (57.9%) | 466 | (32.1%) | 2.9 (1.2–7.2) | 3.0 (1.2–7.7) |
| Nonstunted | 8 | (42.1%) | 988 | (68.0%) | Ref | Ref |
| Acute malnutrition d | ||||||
| MUAC <12.5cm | 8 | (42.1%) | 166 | (11.6%) | 5.4 (2.2–13.4) | 3.3 (1.2–8.6) |
| MUAC ≥12.5cm | 11 | (57.9%) | 1261 | (88.4%) | Ref | |
| Admission status at enrollment visit | ||||||
| Hospitalized | 16 | (72.7%) | 319 | (21.9%) | 9.3 (3.6–23.8) | 14.5 (5.1–41.2) |
| Seen as outpatient | 6 | (27.3%) | 1140 | (78.1%) | Ref | Ref |
| Modified Vesikari scoree | ||||||
| Severe | 18 | (81.8%) | 541 | (37.1%) | 5.9 (2.0–17.4) | 4.4 (1.5–12.9) |
| Moderate | 4 | (18.2%) | 717 | (49.1%) | Ref | Ref |
| Mild | 0 | (0) | 201 | (13.8%) | Not estimable | Not estimable |
| Laboratory | ||||||
| Shigella culture results | ||||||
| Culture positive | 9 | (40.9%) | 698 | (47.8%) | 0.8 (.3–1.8) | 1.1 (.4–2.6) |
| Culture negative | 13 | (59.1%) | 761 | (52.2%) | Ref | Ref |
| Shigella qPCR Ct values f | ||||||
| <20.8 | 11 | (50.0%) | 635 | (44.9%) | 1.5 (.5–4.7) | 1.9 (.6–6.0) |
| 20.8–24.34 | 7 | (31.8%) | 436 | (30.8%) | 1.4 (.4–4.7) | 1.7 (.5–5.8) |
| 24.35–27.89 | 4 | (18.2%) | 343 | (24.3%) | Ref | Ref |
| Other potential etiologyg | ||||||
| Yes | 8 | (36.4%) | 429 | (29.4%) | 1.4 (.6–3.3) | 1.4 (.6–3.3) |
| No | 14 | (63.6%) | 1030 | (70.6%) | Ref | Ref |
Abbreviations: CI, confidence interval; E. coli, Escherichia coli; EAEC, enteroaggregative Escherichia coli; LAZ, length for age z-score; LT-ETEC, heat-labile enterotoxin-producing E. coli; MUAC, mid-upper arm circumference; STEC, Shiga toxin producing E. coli; ST-ETEC, heat-stable enterotoxin-producing E. coli; tEPEC, typical enteropathogenic E. coli; WHO, World Health Organization.
aColumn percentages.
bFrom Cox proportional hazards regression including only the variable of interest in the model.
cFrom Cox proportional hazards regression including the variable of interest, site as an indicator variable, and age as a continuous variable except age model adjusted only for site.
dAmong those ≥6 months of age in whom MUAC is validated.
eAs derived in Kotloff et al, Vaccine, 2017.
fAmong those with qPCR attributable-Shigella (n = 1436).
gBased on site and age-adjusted attributable fraction ≥0.5 for any of the following pathogens: astrovirus, norovirus, rotavirus, sapovirus, adenovirus, Cryptosporidium, E. histolytica, Cyclospora, Isospora, isospora, H. pylori, Aeromonas Campylobacter, Salmonella, V. cholerae, EAEC, ST-ETEC, LT-ETEC, tEPEC, STEC.