Point-of-care lateral flow assays for tuberculosis and cryptococcal antigenuria predict death in HIV infected adults in Uganda.
Point-of-care lateral flow assays for tuberculosis and cryptococcal antigenuria predict death in HIV infected adults in Uganda.
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DOI：
10.1371/journal.pone.0101459
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Dorman SE
中科院分区：
文献类型：
--
作者：
Manabe YC;Nonyane BA;Nakiyingi L;Mbabazi O;Lubega G;Shah M;Moulton LH;Joloba M;Ellner J;Dorman SE
撒哈拉以南非洲地区住院发热患者的死亡率很高，原因是感染艾滋病毒、严重免疫抑制的患者伴有机会性合并感染，特别是播散性结核病 (TB) 和隐球菌病。我们试图确定尿液阿拉伯脂甘露聚糖 (LAM) 和隐球菌抗原尿的侧向层析 (LFA) 阳性结果是否与死亡率相关。乌干达穆拉戈国家转诊医院前瞻性招募了 351 名患有结核病症状且能够提供尿液和痰标本的住院 HIV 阳性成年人，作为横向流动确定结核病 LAM 测试前瞻性准确性评估的一部分。使用 LFA 回顾性检测储存的冷冻尿液中的隐球菌抗原 (CRAG)。我们拟合了多项逻辑回归模型来分析与初次就诊后 2 个月内死亡相关的因素。参与者的 CD4 中位数为 57 (IQR: 14–179) 个细胞/μl，41% (145) 是微生物学确诊的结核病例。 38% (134) 的 LAM LFA 呈阳性，7% (25) 的 CRAG 呈阳性，43% (151) 的尿液检测呈阳性。总体而言，21%（75 人）在头 2 个月内死亡，总共 32%（114 人）在 6 个月内确认死亡。 2 个月时，30% 的 LAM 或 CRAG 阳性患者被确认死亡，而阴性患者的这一比例为 15.0%。在调整后的模型中，LAM 或 CRAG 阳性结果与死亡风险增加相关（RRR 2.29，95% CI：1.29，4.05；P = 0.005）。在住院的 HIV 感染患者中，LAM 或 CRAG LFA 阳性与随后 2 个月内死亡相关。需要进一步的研究来检验 POC 诊断“测试和治疗”方法对以患者为中心的结果的影响。
Mortality in hospitalized, febrile patients in Sub-Saharan Africa is high due to HIV-infected, severely immunosuppressed patients with opportunistic co-infection, particularly disseminated tuberculosis (TB) and cryptococcal disease. We sought to determine if a positive lateral flow assay (LFA) result for urine lipoarabinomannan (LAM) and cryptococcal antigenuria was associated with mortality. 351 hospitalized, HIV-positive adults with symptoms consistent with TB and who were able to provide both urine and sputum specimens were prospectively enrolled at Mulago National Referral Hospital in Uganda as part of a prospective accuracy evaluation of the lateral flow Determine TB LAM test. Stored frozen urine was retrospectively tested for cryptococcal antigen (CRAG) using the LFA. We fitted a multinomial logistic regression model to analyze factors associated with death within 2 months after initial presentation. The median CD4 of the participants was 57 (IQR: 14–179) cells/µl and 41% (145) were microbiologically confirmed TB cases. LAM LFA was positive in 38% (134), 7% (25) were CRAG positive, and 43% (151) were positive for either test in urine. Overall, 21% (75) died within the first 2 months, and a total of 32% (114) were confirmed dead by 6 months. At 2 months, 30% of LAM or CRAG positive patients were confirmed dead compared to 15.0% of those who were negative. In an adjusted model, LAM or CRAG positive results were associated with an increased risk of death (RRR 2.29, 95% CI: 1.29, 4.05; P = 0.005). In hospitalized HIV-infected patients, LAM or CRAG LFA positivity was associated with subsequent death within 2 months. Further studies are warranted to examine the impact of POC diagnostic ‘test and treat’ approach on patient-centered outcomes.
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