Serum phosphate predicts early mortality in adults starting antiretroviral therapy in Lusaka, Zambia: a prospective cohort study.
Serum phosphate predicts early mortality in adults starting antiretroviral therapy in Lusaka, Zambia: a prospective cohort study.
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DOI：
10.1371/journal.pone.0010687
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发表时间：
2010-05-18
期刊：
影响因子：
3.7
通讯作者：
Kabagambe EK
中科院分区：
文献类型：
--
作者：
Heimburger DC;Koethe JR;Nyirenda C;Bosire C;Chiasera JM;Blevins M;Munoz AJ;Shepherd BE;Potter D;Zulu I;Chisembele-Taylor A;Chi BH;Stringer JS;Kabagambe EK
在撒哈拉以南非洲，开始抗逆转录病毒治疗获得性免疫缺陷综合征（艾滋病）的患者在治疗的最初几周内死亡率很高。我们评估了血清磷酸盐与严重营养不良和/或晚期免疫抑制的hiv感染成人早期死亡率的关系。在接受抗逆转录病毒治疗的前12周，对赞比亚卢萨卡142名身体质量指数(BMI) <16 kg/m2或CD4+淋巴细胞计数<50细胞/µL或两者兼有的艾滋病毒感染成人进行了前瞻性随访。监测详细的健康和饮食摄入史、系统回顾、体格检查、血清代谢组（包括磷酸盐）、血清铁蛋白和高敏c反应蛋白（hsCRP）。主要结局是死亡率。基线血清磷酸盐是死亡率的重要预测因子；存活12周的参与者的中位值为1.30 mmol/L（四分位数间距[IQR]: 1.04, 1.43），而死亡的参与者的中位值为1.06 mmol/L（四分位数间距[IQR]: 0.89, 1.27） （p<0.01）。基线磷酸盐每增加0.1 mmol/L，死亡率就会增加（AHR 0.83; 95% CI 0.72 ~ 0.95）。该关联独立于撒哈拉以南非洲地区早期art相关死亡率的其他代谢参数和已知危险因素。虽然参与者的流失是有限的，但这与当地的项目经验是一致的。抗逆转录病毒治疗开始时的低血清磷酸盐是开始抗逆转录病毒治疗伴有严重营养不良或晚期免疫抑制的HIV患者早期死亡的独立预测因子。这可能是一种类似于再进食综合征的生理现象，并可能导致降低死亡率的治疗干预。
Patients starting antiretroviral therapy (ART) for acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa have high rates of mortality in the initial weeks of treatment. We assessed the association of serum phosphate with early mortality among HIV-infected adults with severe malnutrition and/or advanced immunosuppression. An observational cohort of 142 HIV-infected adults initiating ART in Lusaka, Zambia with body mass index (BMI) <16 kg/m2 or CD4+ lymphocyte count <50 cells/µL, or both, was followed prospectively during the first 12 weeks of ART. Detailed health and dietary intake history, review of systems, physical examination, serum metabolic panel including phosphate, and serum ferritin and high-sensitivity C-reactive protein (hsCRP) were monitored. The primary outcome was mortality. Baseline serum phosphate was a significant predictor of mortality; participants alive at 12 weeks had a median value of 1.30 mmol/L (interquartile range [IQR]: 1.04, 1.43), compared to 1.06 mmol/L (IQR: 0.89, 1.27) among those who died (p<0.01). Each 0.1 mmol/L increase in baseline phosphate was associated with an incremental decrease in mortality (AHR 0.83; 95% CI 0.72 to 0.95). The association was independent of other metabolic parameters and known risk factors for early ART-associated mortality in sub-Saharan Africa. While participant attrition represented a limitation, it was consistent with local program experience. Low serum phosphate at ART initiation was an independent predictor of early mortality among HIV patients starting ART with severe malnutrition or advanced immunosuppression. This may represent a physiologic phenomenon similar to refeeding syndrome, and may lead to therapeutic interventions that could reduce mortality.
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DOI：
10.1001/jama.1948.02890520001001
发表时间：
1948-01-01
影响因子：
120.7
作者：
BROZEK, J;CHAPMAN, CB;KEYS, A
通讯作者：
KEYS, A
DOI：
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发表时间：
2007-01-01
影响因子：
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作者：
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Braitstein, P;Brinkhof, MWG;Egger, M
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DOI：
10.1080/09540120701594776
发表时间：
2008-01-01
影响因子：
1.7
作者：
Krebs, D. W.;Chi, B. H.;Stringer, J. S. A.
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Stringer, J. S. A.