The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis.
The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis.
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DOI：
10.1093/cid/ciu596
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发表时间：
2014-12-01
期刊：
影响因子：
--
通讯作者：
Boulware DR
中科院分区：
文献类型：
--
作者：
Rolfes MA;Hullsiek KH;Rhein J;Nabeta HW;Taseera K;Schutz C;Musubire A;Rajasingham R;Williams DA;Thienemann F;Muzoora C;Meintjes G;Meya DB;Boulware DR
对撒哈拉以南非洲的隐球菌性脑膜炎患者进行了重复腰椎穿刺术(LP)的颅内压管理。无论初始压力如何，在隐球菌诊断后不久进行至少1次额外的LP与降低急性死亡风险有关。前言： 隐球菌性脑膜炎是撒哈拉以南非洲成人脑膜炎最常见的原因。颅内压升高在隐球菌病中很常见。先前的研究表明，高的颅内压与死亡率有关，指南建议频繁的腰椎穿刺术(LP)来控制颅内压。然而，脂蛋白对隐球菌相关死亡率的影响程度尚不清楚。方法：总之， 观察了在乌干达和南非进行的隐球菌最佳抗逆转录病毒治疗试验(COAT)筛选的248名人类免疫缺陷病毒相关性隐球菌性脑膜炎患者。患者接受LP以诊断脑膜炎，随后的LP治疗被推荐用于颅内压升高(>；250 mm H2O)或出现新症状。我们比较了接受至少1次治疗性LP的患者和未接受治疗性LP的患者之间11天的存活率。COAT试验在7-11天对受试者进行随机化；因此，随访在死亡、随机化或11天停止。结果： 75人(30%)至少有一次治疗性LP。接受治疗性LP的患者与未接受治疗性LP的患者相比，脑脊液(CSF)开放压力更高，脑脊液真菌负荷更高，基线时精神状态更有可能发生改变。173名未接受治疗性LP的患者中有31人死亡(18%)，75名至少有1名治疗性LP的患者中有5人死亡(7%)。调整后的相对死亡风险为0.31(95%可信区间：.12-.82)。无论基线的开放压力如何，都观察到了这种关联。结论：无论初始颅内压如何， 治疗LP与相对改善69%的存活率有关。治疗性脂蛋白的作用应重新评估。
Intracranial pressure management with repeat lumbar puncture (LP) was investigated in patients with cryptococcal meningitis in sub-Saharan Africa. Conducting at least 1 additional LP soon after cryptococcal diagnosis was related to decreased risk of acute mortality regardless of initial pressure. Introduction. Cryptococcal meningitis is the most common cause of adult meningitis in sub-Saharan Africa. Raised intracranial pressure (ICP) is common in cryptococcosis. Prior studies suggest elevated ICP is associated with mortality, and guidelines recommend frequent lumbar punctures (LPs) to control ICP. However, the magnitude of the impact of LPs on cryptococcal-related mortality is unknown. Methods. In sum, 248 individuals with human immunodeficiency virus (HIV)-associated cryptococcal meningitis, screened for the Cryptococcal Optimal ART Timing (COAT) trial in Uganda and South Africa, were observed. Individuals received an LP to diagnose meningitis, and subsequent therapeutic LPs were recommended for elevated ICP (>250 mmH2O) or new symptoms. We compared survival, through 11 days, between individuals receiving at least 1 therapeutic LP with individuals not receiving therapeutic LPs. The COAT trial randomized subjects at 7–11 days; thus, follow-up stopped at time of death, randomization, or 11 days. Results. Seventy-five (30%) individuals had at least 1 therapeutic LP. Individuals receiving therapeutic LPs had higher cerebrospinal fluid (CSF) opening pressures, higher CSF fungal burdens, and were more likely to have altered mental status at baseline than those with no therapeutic LPs. Thirty-one deaths (18%) occurred among 173 individuals without a therapeutic LP and 5 deaths (7%) among 75 with at least 1 therapeutic LP. The adjusted relative risk of mortality was 0.31 (95% confidence interval: .12–.82). The association was observed regardless of opening pressure at baseline. Conclusions. Therapeutic LPs were associated with a 69% relative improvement in survival, regardless of initial intracranial pressure. The role of therapeutic LPs should be reevaluated.
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影响因子：
3.7
作者：
Kisenge, Peter R.;Hawkins, Alexander T.;Houpt, Eric R.
通讯作者：
Houpt, Eric R.
DOI：
10.1097/00042560-199802010-00006
发表时间：
1998-02-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY
影响因子：
--
作者：
Fessler, RD;Sobel, J;Diaz, FG
通讯作者：
Diaz, FG
影响因子：
3.3
作者：
Lee, SC;Dickson, DW;Casadevall, A
通讯作者：
Casadevall, A
影响因子：
168.9
作者：
Brouwer, AE;Rajanuwong, A;Harrison, TS
通讯作者：
Harrison, TS
DOI：
10.7196/samj.3515
发表时间：
2010-06-01
期刊：
SAMJ: South African Medical Journal
影响因子：
--
作者：
Jarvis, Joseph N;Meintjes, Graeme;Harrison, Thomas S
通讯作者：
Harrison, Thomas S