Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe
Anaemia is an independent predictive marker for clinical prognosis in HIV-infected patients from across Europe
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DOI：
10.1097/00002030-199905280-00010
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发表时间：
1999-05-28
期刊：
影响因子：
3.8
通讯作者：
Lundgren, JD
中科院分区：
文献类型：
--
作者：
Mocroft, A;Kirk, O;Lundgren, JD
目的：描述血红蛋白随时间的变化，并确定当前血红蛋白、CD 4淋巴细胞计数和病毒载量在欧洲患者中的联合预后价值。患者：分析包括来自EuroSIDA的6725例患者，EuroSIDA是一个观察性、前瞻性队列，来自欧洲各地的HIV患者。正常血红蛋白定义为血红蛋白男性大于14 g/dl，女性大于12 g/dl;轻度贫血男性为8-14 g/dl，女性为8-12 g/dl;严重贫血的定义是男女均低于8克/分升。线性回归技术被用来估计血红蛋白的年度变化，标准的生存技术被用来描述疾病的进展和死亡的风险。结果：在招聘，研究，40.4%的血红蛋白水平正常，58.2%有轻度贫血和1.4%有严重贫血。招募后12个月，无贫血患者估计死亡的患者比例为3.1% [95%置信区间（CI）2.3-3.9]，轻度贫血患者为15.9%（95% CI 14.5-17.2），重度贫血患者为40.8%（95% CI 27.9-53.6; P < 0.0001）。在一个多变量、时间更新的考克斯比例风险模型中，将人口统计学因素、艾滋病状态和每种抗逆转录病毒治疗作为时间依赖性协变量进行调整，最新血红蛋白水平降低1 g/dl，死亡风险增加57% [相对风险（RH）1.57; 95%CI 1.41-1.75; P < 0.0001]，最近的CD 4淋巴细胞计数下降50%，风险增加51%（相对湿度1.51; 95%CI 1.35-1.70; P < 0.0001），最近病毒载量的对数增加使风险增加37%结论：重度贫血在这些患者中很少发生，但与更快的疾病进展速度相关。在CD 4淋巴细胞计数和病毒载量相似的患者中，血红蛋白的最新值是死亡的一个强有力的独立预后指标。(C)1999年利平科特威廉姆斯&威尔金斯。
Objectives: To describe changes in haemoglobin over time and to determine the joint prognostic value of the current haemoglobin, CD4 lymphocyte count and viral load among patients from across Europe.Patients: The analysis included 6725 patients from EuroSIDA, an observational, prospective cohort of patients with HIV from across Europe.Methods: Normal haemoglobin was defined as haemoglobin greater than 14 g/dl for men and 12 g/dl for women; mild anaemia was 8-14 g/dl for men and 8-12 g/dl for women; severe anaemia was defined as less than 8 g/dl for both males and females. Linear regression techniques were used to estimate the annual change in haemoglobin; standard survival techniques were used to describe disease progression and risk of death.Results: At recruitment, to the study, 40.4% had normal levels of haemoglobin, 58.2% had mild anaemia and 1.4% had severe anaemia. At 12 months after recruitment, the proportion of patients estimated to have died was 3.1% [95% confidence interval (CI) 2.3-3.9] for patients without anaemia, 15.9% for patients with mild anaemia (95% CI 14.5-17.2) and 40.8% for patients with severe anaemia (95% CI 27.9-53.6; P < 0.0001). In a multivariate, time-updated Cox proportional hazards model, adjusted for demographic factors, AIDS status and each antiretroviral treatment as time-dependent covariates, a 1 g/dl decrease in the latest haemoglobin level increased the hazard of death by 57% [relative hazard (RH) 1.57; 95% CI 1.41-1.75; P < 0.0001], a 50% drop in the most recent CD4 lymphocyte count increased the hazard by 51% (RH 1.51; 95% CI 1.35-1.70; P < 0.0001) and a log increase in the latest viral load increased the hazard by 37% (RH 1.37; 95% CI 1.15-1.63; P = 0.0005).Conclusions: Severe anaemia occurred infrequently among these patients but was associated with a much faster rate of disease progression. Among patients with similar CD4 lymphocyte counts and viral load, the latest value of haemoglobin was a strong independent prognostic marker for death. (C) 1999 Lippincott Williams & Wilkins.