Admitted AIDS-associated Kaposi sarcoma patients: Indications for admission and predictors of mortality.
Admitted AIDS-associated Kaposi sarcoma patients: Indications for admission and predictors of mortality.
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DOI：
10.1097/md.0000000000022415
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发表时间：
2020-09-25
期刊：
影响因子：
1.6
通讯作者：
Ngalamika O
中科院分区：
文献类型：
--
作者：
Vally F;Selvaraj WMP;Ngalamika O
卡波西肉瘤（KS）是一种与艾滋病相关的血管增殖性恶性肿瘤，具有高发病率和死亡率。在撒哈拉以南非洲等高发地区，大多数 KS 患者就诊时已处于晚期。收治的 KS 患者死亡率很高。与收治 KS 患者死亡率相关的因素尚不清楚。我们进行了回顾性档案审查，以确定赞比亚收治的 HIV 相关（流行）KS 患者的入院原因并确定与死亡率相关的因素。收集基线研究变量，并对患者从入院到出院或死亡进行回顾性随访。收治的流行性 KS 患者的死亡率高达 20%。最常见的入院原因包括晚期 KS 病、严重贫血、呼吸道感染和败血症。大多数（48%）入院患者入院时已处于临床晚期并伴有内脏受累。单变量分析中死亡率的临床预测因素包括内脏 KS [比值比 (OR) = 13.74； 95%置信区间(95% CI) = 1.68–113; P = 0.02）、发热（OR = 26；95% CI= 4.85–139；P = .001）和败血症（OR = 35.56；95% CI = 6.05–209；P = .001）。死亡率与出院率相比，基线血红蛋白水平（5.6 vs 8.2 g/dL；P = .001）和基线血小板计数（63 x 10^9/L vs 205 x 10^9/L；P = .01）显着较低。死亡率与出院时的基线白细胞计数较高（13.78 x 10^9/L vs 5.58 x 10^9/L；P = .01），入院时的 HIV-1 病毒载量在死亡率与出院时较高（47,607 vs 40 copies/μL；P = .01）。 P = .02)。然而，在控制混杂因素后，只有脓毒症（或脓毒症的体征和症状）与死亡率独立相关。总之，流行性 KS 患者入院的常见原因包括晚期疾病、严重贫血、呼吸道感染以及脓毒症的体征和症状。脓毒症的体征和症状是这些患者死亡率的独立预测因素。
Kaposi sarcoma (KS) is an AIDS-defining angioproliferative malignancy associated with high morbidity and mortality. Most KS patients in regions with high incidence such as sub-Saharan Africa present late with advanced stage disease. Admitted KS patients have high mortality rates. Factors associated with mortality of admitted KS patients are poorly defined. We conducted a retrospective file review to ascertain reasons for admission and identify factors associated with mortality of admitted HIV-associated (epidemic) KS patients in Zambia. Baseline study variables were collected, and patients were retrospectively followed from admission to time of discharge or death. Mortality rate for admitted epidemic KS patients was high at 20%. The most common reasons for admission included advanced KS disease, severe anemia, respiratory tract infections, and sepsis. The majority (48%) of admitted patients had advanced clinical stage with visceral involvement on admission. Clinical predictors of mortality on univariate analysis included visceral KS [odds ratio (OR) = 13.74; 95% confidence interval (95% CI) = 1.68–113; P = 0.02), fever (OR = 26; 95% CI = 4.85–139; P = .001), and sepsis (OR = 35.56; 95% CI = 6.05–209; P = .001). Baseline hemoglobin levels (5.6 vs 8.2 g/dL; P = .001) and baseline platelet counts (63 x 10^9/L vs 205 x 10^9/L; P = .01) were significantly lower in mortalities vs discharges. Baseline white cell counts were higher in mortalities vs discharges (13.78 x 10^9/L vs 5.58 x 10^9/L; P = .01), and HIV-1 viral loads at the time of admission were higher in mortalities vs discharges (47,607 vs 40 copies/μL; P = .02). However, only sepsis (or signs and symptoms of sepsis) were independently associated with mortality after controlling for confounders. In conclusion, common reasons for admission of epidemic KS patients include advanced disease, severe anemia, respiratory tract infections, and signs and symptoms of sepsis. Signs and symptoms of sepsis are independent predictors of mortality in these patients.