Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania.
Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania.
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DOI：
10.1186/1471-2334-8-52
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发表时间：
2008-04-22
影响因子：
3.7
通讯作者：
Bruun JN
中科院分区：
文献类型：
--
作者：
Johannessen A;Naman E;Ngowi BJ;Sandvik L;Matee MI;Aglen HE;Gundersen SG;Bruun JN
对非洲抗逆转录病毒疗法(ART)项目的研究表明，初始死亡率很高。导致这一高死亡率的因素描述得很差。本研究的目的是评估在坦桑尼亚一家乡村医院开始抗逆转录病毒治疗的艾滋病毒感染者的死亡率，并确定死亡率的预测因素。这是一项对320名在2003年10月至2006年11月期间开始接受抗逆转录病毒治疗的天真成年人进行的队列研究。没有可靠的CD4细胞计数，因此根据世卫组织和坦桑尼亚指南的临床标准开始抗逆转录病毒治疗。Kaplan-Meier模型用于估计死亡率，Cox比例风险模型用于确定死亡率的预测因素。患者平均随访10.9个月(IQR2.9-19.5)。总体而言，95名患者死亡，其中59人在开始抗逆转录病毒治疗后3个月内死亡。3个月、12个月和36个月的死亡率分别为19.2%、29.0%和40.7%。死亡的独立预测因素是重度贫血(血红蛋白和1t；8g/dL；调整危险比[AHR]9.20；95%可信区间2.05-41.3)、中度贫血(血红蛋白8-9.9g/dL；AHR 7.50；95%可信区间1.77-31.9)、血小板减少(血小板计数和lt 150×109/L；AHR 2.30；95%可信区间1.33-3.99)和严重营养不良(体重指数和体重指数；16 kg/m2；AHR 2.12；95%CI 1.06-4.24)。重度贫血患者的一年死亡率估计为55.2%，而非贫血患者的一年死亡率为3.7%(P<；0.001)。死亡率很高，大多数死亡发生在开始抗逆转录病毒治疗的3个月内。贫血、血小板减少和严重营养不良是死亡率的独立预测因素。基于血红蛋白水平的预后模型似乎是在资源有限的情况下进行初始风险评估的有用工具。
Studies of antiretroviral therapy (ART) programs in Africa have shown high initial mortality. Factors contributing to this high mortality are poorly described. The aim of the present study was to assess mortality and to identify predictors of mortality in HIV-infected patients starting ART in a rural hospital in Tanzania. This was a cohort study of 320 treatment-naïve adults who started ART between October 2003 and November 2006. Reliable CD4 cell counts were not available, thus ART initiation was based on clinical criteria in accordance with WHO and Tanzanian guidelines. Kaplan-Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality. Patients were followed for a median of 10.9 months (IQR 2.9–19.5). Overall, 95 patients died, among whom 59 died within 3 months of starting ART. Estimated mortality was 19.2, 29.0 and 40.7% at 3, 12 and 36 months, respectively. Independent predictors of mortality were severe anemia (hemoglobin <8 g/dL; adjusted hazard ratio [AHR] 9.20; 95% CI 2.05–41.3), moderate anemia (hemoglobin 8–9.9 g/dL; AHR 7.50; 95% CI 1.77–31.9), thrombocytopenia (platelet count <150 × 109/L; AHR 2.30; 95% CI 1.33–3.99) and severe malnutrition (body mass index <16 kg/m2; AHR 2.12; 95% CI 1.06–4.24). Estimated one year mortality was 55.2% in patients with severe anemia, compared to 3.7% in patients without anemia (P < 0.001). Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART. Anemia, thrombocytopenia and severe malnutrition were strong independent predictors of mortality. A prognostic model based on hemoglobin level appears to be a useful tool for initial risk assessment in resource-limited settings.
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影响因子：
11.8
作者：
Ivers, LC;Kendrick, D;Doucette, K
通讯作者：
Doucette, K
DOI：
10.1097/00042560-200201010-00007
发表时间：
2002-01-01
期刊：
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
影响因子：
--
作者：
Moore, RD;Forney, D
通讯作者：
Forney, D
影响因子：
39.2
作者：
Justice, AC;Covinsky, KE;Berlin, JA
通讯作者：
Berlin, JA
影响因子：
3.8
作者：
Coetzee, D;Hildebrand, K;Goemaere, E
通讯作者：
Goemaere, E
影响因子：
3.8
作者：
Etard, JF;Ndiaye, I;Delaporte, E
通讯作者：
Delaporte, E