Cerebral Oximetry for Detecting High-mortality Risk Patients with Cryptococcal Meningitis.
Cerebral Oximetry for Detecting High-mortality Risk Patients with Cryptococcal Meningitis.
复制标题
用于检测隐球菌脑膜炎的高病态风险患者的大脑血氧饱和度。
DOI：
10.1093/ofid/ofy105
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发表时间：
2018-06-01
影响因子：
4.2
通讯作者：
ASTRO-CM Trial Team
中科院分区：
文献类型：
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作者：
Diehl JW;Hullsiek KH;Okirwoth M;Stephens N;Abassi M;Rhein J;Meya DB;Boulware DR;Musubire AK;ASTRO-CM Trial Team
隐球菌是非洲成人脑膜炎最常见的原因，50%-70%的人经历颅内压升高。脑血氧饱和度是一种无创近红外光谱技术，用于监测局部脑组织氧合百分比（rSO 2）。我们评估了脑氧饱和度测定是否能预测脑膜炎死亡率。我们在2016年4月至2017年9月期间对121名乌干达人进行了隐球菌脑膜炎诊断后14天内的脑血氧测定。我们通过多变量逻辑回归和与其他临床因素的相关性评估了基线rSO 2与死亡率的相关性。我们使用混合效应模型比较了初始rSO 2 <30%与≥30%的纵向变化组。我们测量了腰椎穿刺（LP）前后%rSO2的变化。初始rSO 2中位数（四分位数间距）为36%（29%-42%），29%（35/121）的rSO 2 <30%。对于30天死亡率，未校正的比值比（rSO 2每增加5%）为0.73（95%置信区间[CI]，0.58至0.91; P = 0.005）。初始rSO 2 <30%的患者30天死亡率比初始rSO 2 ≥ 30%的患者高3.4（95%CI，1.5 - 8.0）。血红蛋白与初始rSO 2相关（rho = 0.54; P <0.001），但rSO 2与脉搏血氧饱和度、颅内压、脑灌注压或定量脑脊液培养无相关性，腰椎穿刺前后rSO 2无变化。在初始rSO 2 <30%的组中，纵向rSO 2测量变化低15%（95% CI，12%至18%）。隐球菌性脑膜炎和低脑氧饱和度（rSO 2 < 30%）的个体死亡率高。脑血氧测定可能可用作死亡率的预后标志物。应在试验中测试改善rSO 2的有针对性的干预措施，以降低脑膜炎的死亡率。
Cryptococcus is the commonest cause of adult meningitis in Africa, with 50%–70% experiencing increased intracranial pressure. Cerebral oximetry is a noninvasive near-infrared spectroscopy technology to monitor percent regional cerebral tissue oxygenation (rSO2). We assessed if cerebral oximetry predicts meningitis mortality. We performed cerebral oximetry within 14 days of cryptococcal meningitis diagnosis on 121 Ugandans from April 2016 to September 2017. We evaluated baseline rSO2 association with mortality by multivariable logistic regression and correlation with other clinical factors. We compared groups formed by initial rSO2 <30% vs ≥30% for longitudinal change with mixed effects models. We measured change in %rSO2 before and after lumbar puncture (LP). The median initial rSO2 (interquartile range) was 36% (29%–42%), and it was <30% in 29% (35/121). For 30-day mortality, the unadjusted odds ratio (per 5% increase in rSO2) was 0.73 (95% confidence interval [CI], 0.58 to 0.91; P = .005). Those with initial rSO2 <30% had 3.4 (95% CI, 1.5 to 8.0) higher odds of 30-day mortality than those with initial rSO2 ≥30%. Hemoglobin correlated with initial rSO2 (rho = .54; P < .001), but rSO2 did not correlate with pulse oximetry, intracranial pressure, cerebral perfusion pressure, or quantitative cerebrospinal fluid culture, and rSO2 was unchanged pre/post–lumbar punctures. The longitudinal rSO2 measurements change was 15% (95% CI, 12% to 18%) lower in the group with initial rSO2 <30%. Individuals with cryptococcal meningitis and low cerebral oximetry (rSO2 < 30%) have high mortality. Cerebral oximetry may be useful as a prognostic marker of mortality. Targeted interventions to improve rSO2 should be tested in trials to try to decrease mortality in meningitis.
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DOI：
10.1093/cid/ciu596
发表时间：
2014-12-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
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
通讯作者：
Boulware DR
影响因子：
3
作者：
Tugume L;Morawski BM;Abassi M;Bahr NC;Kiggundu R;Nabeta HW;Hullsiek KH;Taseera K;Musubire AK;Schutz C;Muzoora C;Williams DA;Rolfes MA;Meintjes G;Rhein J;Meya DB;Boulware DR
通讯作者：
Boulware DR
影响因子：
11.8
作者：
Graybill, JR;Sobel, J;Dismukes, W
通讯作者：
Dismukes, W
影响因子：
1.6
作者：
Mousa, Wesam F.;Mowafi, Hany A.;Al-Gameel, Haytham Z.
通讯作者：
Al-Gameel, Haytham Z.
影响因子：
--
作者：
NEMOTO, EM;FRANKEL, HM
通讯作者：
FRANKEL, HM