Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome
Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome
复制标题
DOI：
10.1016/s0735-1097(03)00256-0
复制
发表时间：
2003-05-07
影响因子：
24
通讯作者：
Lipshultz, SE
中科院分区：
文献类型：
--
作者：
Al-Attar, I;Orav, J;Lipshultz, SE
目的探讨儿童获得性免疫缺陷综合征(AIDS)心血管功能障碍的发生率及其预测因素：背景心血管表现在艾滋病儿童中较为常见，但临床上可能具有隐匿性。我们测试了艾滋病诊断时的临床和人口学特征对严重心脏事件、死亡和心脏病死亡的预测能力。结果从艾滋病诊断到死亡或随访结束的中位时间为1.0年(范围为1周至7.9年)。19名患者(28%)在艾滋病诊断后经历了严重的心脏事件。在43名死亡患者中，15名(35%)有心功能不全。多变量分析显示，反复的细菌感染、消瘦、脑病、男性和艾滋病诊断的前一年是严重心脏事件的预测因素(相对危险度[RR]分别为9.3、6.9、4.7、4.1和0.76，p<；0.05)。消瘦、脑病、年龄调整后的CD4细胞计数低、年龄调整后的免疫球蛋白G(Ig G)水平低以及被诊断为艾滋病的年龄较早的一年增加了全因死亡的风险(RR分别为8.9、5.1、2.7、0.82和0.8，p分别小于或等于0.02)。男性、低年龄调整的CD4细胞计数和低年龄调整的免疫球蛋白水平增加了心源性死亡的风险(RR分别为16.9、4.2和0.68，p<0.05)。结论艾滋病儿童中严重心脏事件和心源性死亡较为常见。反复出现的细菌感染、消瘦、脑病、男性、低CD4和Ig G水平，以及艾滋病确诊的较早一年等因素可能会确定高危患者。(C)2003年，由美国心脏病学会基金会提供。
OBJECTIVES The aim of this study was to determine the prevalence of cardiovascular dysfunction and its predictors in children with acquired immunodeficiency syndrome (AIDS):BACKGROUND Cardiovascular manifestations are common among children with AIDS but may be clinically occult.METHODS We reviewed the medical records, echocardiograms, electrocardiograms, and Holter monitor studies of 68 children with AIDS. We tested clinical and demographic characteristics at the time of AIDS diagnosis for their ability to predict serious cardiac events, death, and cardiac death.RESULTS The median time from AIDS diagnosis to death or end of follow-up was 1.0 year (range, 1 week to 7.9 years). Nineteen patients (28%) experienced serious cardiac events after AIDS diagnosis. Of 43 patients who died, 15 (35%) had cardiac dysfunction. Multivariable analyses revealed that recurrent bacterial infections, wasting, encephalopathy, male gender, and an earlier year of AIDS diagnosis were predictors of serious cardiac events (relative risk [RR] = 9.3, 6.9, 4.7, 4.1, and 0.76, respectively, p < 0.05). Wasting, encephalopathy, a low age-adjusted CD4 count, a low age-adjusted immunoglobulin G (IgG) level, and an earlier year of AIDS diagnosis increased the risk of all-cause mortality (RR = 8.9, 5.1, 2.7, 0.82, and 0.8, respectively, p less than or equal to 0.02). Male gender, a low age-adjusted CD4 count, and a low age-adjusted IgG level increased the risk for cardiac death (RR = 16.9, 4.2, and 0.68, respectively, p less than or equal to 0.05).CONCLUSIONS Serious cardiac events and cardiac death are common among children with AIDS. Factors such as recurrent bacterial infections, wasting, encephalopathy, male gender, low CD4 and IgG levels, and an earlier year at AIDS diagnosis may identify high-risk patients. (C) 2003 by the American College of Cardiology Foundation.