A new preadmission staging system for predicting inpatient mortality from HIV-associated Pneumocystis carinii pneumonia in the early highly active antiretroviral therapy (HAART) era
A new preadmission staging system for predicting inpatient mortality from HIV-associated Pneumocystis carinii pneumonia in the early highly active antiretroviral therapy (HAART) era
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DOI：
10.1164/ajrccm.161.4.9906072
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发表时间：
2000-04-01
影响因子：
24.7
通讯作者：
Bennett, CL
中科院分区：
文献类型：
--
作者：
Arozullah, AM;Yarnold, PR;Bennett, CL
人类免疫缺陷病毒（HIV）感染的一种常见严重并发症是卡氏肺孢子虫肺炎（PCP）。最近，随着PCP预防和多药抗逆转录病毒治疗的使用越来越多，HIV感染的临床表现发生了巨大变化，PCP住院死亡率的预测因素也可能发生变化。我们开发了一种新的分期系统，用于预测1995年至1997年收治的HIV相关PCP患者的住院死亡率。1995年至1997年期间，在美国7个大都市地区的78家医院，1，660名因HIV相关PCP住院的患者接受了表格审查。总住院死亡率为11.3%。分层最优分类树分析确定了一个有序的五类分期系统，基于三个预测因素：消瘦、肺泡动脉氧梯度（AaPo（2））和血清白蛋白水平。死亡率随阶段增加：第1阶段为3.7%，第2阶段为8.5%，第3阶段为16.1%，第4阶段为23.3%，第5阶段为49.1%。这种新的分期系统可能有助于当前疾病严重程度的调整，同时探索医院和城市之间HIV相关PCP住院死亡率的当前变化。
A common severe complication of human immunodeficiency virus (HIV) infection has been Pneumocystis carinii pneumonia (PCP). Recently, with increasing use of PCP prophylaxis and multidrug antiretroviral therapy, the clinical manifestations of HIV infection have changed dramatically and the predictors of inpatient mortality for PCP may have also changed. We developed a new staging system for predicting inpatient mortality for patients with HIV-associated PCP admitted between 1995 and 1997. Trained abstractors per formed chart reviews of 1,660 patients hospitalized with HIV-associated PCP between 1995 and 1997 at 78 hospitals in seven metropolitan areas in the United States. The overall inpatient mortality rate was 11.3%. Hierarchically optimal classification tree analysis identified an ordered five-category staging system based on three predictors: wasting, alveolar-arterial oxygen gradient (AaPo(2)), and serum albumin level. The mortality rate increased with stage: 3.7% for Stage 1, 8.5% for Stage 2, 16.1% for Stage 3, 23.3% for Stage 4, and 49.1% for Stage 5. This new staging system may be useful for severity of illness adjustment in the current era while exploring current variation in HIV-associated PCP inpatient mortality rates among hospitals and across cities.