Prognostic implications of baseline anaemia and changes in haemoglobin concentrations with amphotericin B therapy for cryptococcal meningitis.
Prognostic implications of baseline anaemia and changes in haemoglobin concentrations with amphotericin B therapy for cryptococcal meningitis.
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DOI：
10.1111/hiv.12387
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发表时间：
2017-01
期刊：
影响因子：
3
通讯作者：
Boulware DR
中科院分区：
文献类型：
--
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
对于患有隐球菌性脑膜炎的 HIV 感染者，贫血是基于两性霉素 B 的诱导治疗的常见毒性。我们试图研究两性霉素相关贫血对生存的影响。我们使用乌干达和南非试验参与者的数据来描述从诊断到诊断后 12 周的血红蛋白浓度变化。根据隐球菌性脑膜炎诊断时的血红蛋白和两性霉素诱导期间的最低血红蛋白值对贫血严重程度进行分类。 Cox 比例风险模型估计了 2 周和 10 周的死亡风险。我们还估计了两性霉素诱导期间血红蛋白最低点<8.5g/dL 且入组后存活≥2 周的参与者的 10 周死亡风险。基线血红蛋白≥8.5g/dL的参与者中，脑膜炎诊断时的中位血红蛋白浓度为11.5g/dL（IQR：9.7至13；n=311），从诊断到最低值下降了4.2g/dL（95%CI：-4.6至-3.8；P<0.001；n=148）。第 2 周时，中位血红蛋白为 8.1g/dL（IQR：6.5 至 9.5），到 4 周时增加至 9.4g/dL（IQR：8.2 至 10.9），并持续增加至 12 周。与血红蛋白≥8.5g/dL的参与者相比，诊断时血红蛋白<8.5g/dL的参与者的死亡风险在2周（风险比（HR）=2.7；95%CI：1.5-4.9；P<0.01）和10周（HR=1.8；95%CI：1.1-2.2 P=0.03）内升高。两性霉素引起的新发贫血与 10 周死亡率没有统计学相关性（HR=2.0；95%CI：0.5-9.1；P=0.4）。两性霉素会导致血红蛋白显着下降，但这种下降大多是暂时的，不会影响 10 周死亡率。基线时患有中度至危及生命贫血的个体在入组后 2 周和 10 周时死亡风险较高。
Anemia represents a common toxicity with amphotericin B-based induction therapy for HIV-infected persons with cryptococcal meningitis. We sought to examine the impact of amphotericin-related anemia on survival. We used data from Ugandan and South African trial participants to characterize variation of hemoglobin concentrations from diagnosis to 12 weeks post-diagnosis. Anemia severity was classified based on hemoglobin at cryptococcal meningitis diagnosis, and nadir hemoglobin values during amphotericin induction. Cox proportional hazard models estimated 2-and 10-week mortality risk. We also estimated 10-week mortality risk among participants with nadir hemoglobin <8.5g/dL during amphotericin induction and who survived ≥2 weeks post-enrollment. The median hemoglobin concentration at meningitis diagnosis was 11.5g/dL (IQR: 9.7 to 13; n=311) with a decline of 4.2g/dL (95%CI: −4.6 to −3.8; P<0.001; n=148) from diagnosis to nadir value among participants with baseline hemoglobin ≥8.5g/dL. At 2 weeks, median hemoglobin was 8.1g/dL (IQR: 6.5 to 9.5) increasing to 9.4g/dL (IQR: 8.2 to 10.9) by 4 weeks and continuing to increase through 12 weeks. Among participants with hemoglobin <8.5g/dL at diagnosis, mortality risk was elevated through 2-weeks (Hazard Ratio (HR)=2.7; 95%CI: 1.5-4.9; P<0.01) and 10-weeks (HR=1.8; 95%CI: 1.1-2.2 P=0.03), relative to those with hemoglobin ≥8.5g/dL. New onset anemia occurring with amphotericin did not have a statistical association with 10-week mortality (HR=2.0; 95%CI: 0.5-9.1; P=0.4). Amphotericin induces significant hemoglobin declines, which were mostly transient and did not impact 10-week mortality. Individuals with moderate to life-threatening anemia at baseline had a higher mortality risk at 2- and 10-weeks post-enrollment.
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影响因子：
3.7
作者：
Dromer F;Bernede-Bauduin C;Guillemot D;Lortholary O;French Cryptococcosis Study Group
通讯作者：
French Cryptococcosis Study Group
影响因子：
3.8
作者：
Park, Benjamin J.;Wannemuehler, Kathleen A.;Chiller, Tom A.
通讯作者：
Chiller, Tom A.
影响因子：
168.9
作者：
Brouwer, AE;Rajanuwong, A;Harrison, TS
通讯作者：
Harrison, TS
DOI：
10.1097/01.qai.0000166374.16222.a2
发表时间：
2005-10-01
影响因子：
3.6
作者：
O'Brien, ME;Kupka, R;Fawzi, WW
通讯作者：
Fawzi, WW
DOI：
10.1086/383031
发表时间：
2004-05-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Volberding, Paul A;Levine, Alexandra M;Saag, Michael
通讯作者：
Saag, Michael