National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Cliffbrook Campus, Coogee, Sydney, New South Wales, Australia.
AIDS. 2010 Jul 31;24(12):1877-86. doi: 10.1097/QAD.0b013e32833b1b26.
To investigate the relative predictive value of CD4(+) metrics for serious clinical endpoints.
Observational.
Patients (3012; 20 317 person-years) from control arms of ESPRIT and SILCAAT were followed prospectively. We used Cox regression to identify CD4(+) metrics (latest, baseline and nadir CD4(+) cell count, latest CD4(+)%, time spent with CD4(+) count below certain thresholds and CD4(+) slopes) independently predictive of all-cause mortality, non-AIDS deaths, non-AIDS (cardiovascular, hepatic, renal and non-AIDS malignancy) and AIDS events. Akaike information criteria (AIC) were calculated for each model. Significant metrics (P < 0.05) were then additionally adjusted for latest CD4(+) cell count.
Non-AIDS deaths occurred at a higher rate than AIDS deaths [rate ratio: 6.48, 95% confidence interval (CI) 5.1-8.1], and non-AIDS events likewise (rate ratio: 1.72, 95% CI 1.65-1.79). Latest CD4(+) cell count was strongly predictive of lower risk of death (hazard ratio per log2 rise: 0.48, 95% CI 0.43-0.54), with lowest AIC of all metrics. CD4(+) slope over seven visits, after additional adjustment for latest CD4(+) cell count, was the only metric to be an independent predictor for all-cause (hazard ratio for slope <-10 cells/microl per month vs. 0 +/- 10: 3.04, 95% CI 1.98-4.67) and non-AIDS deaths (hazard ratio for slope <-10 cells/microl per month vs. 0 +/- 10: 2.62, 95% CI 1.62-4.22). Latest CD4(+) cell count (per log(2) rise) was the best predictor across all four endpoints and predicted hepatic (hazard ratio 0.46, 95% CI 0.33-0.63) and renal events (hazard ratio 0.39, 95% CI 0.21-0.70), but not cardiovascular events (hazard ratio 1.05, 95% CI 0.77-1.43) or non-AIDS cancers (hazard ratio 0.78, 95% CI 0.59-1.03).
Latest CD4(+) cell count is the best predictor of serious endpoints. CD4(+) slope independently predicts all-cause and non-AIDS deaths.
研究 CD4(+) 指标对严重临床终点的相对预测价值。
观察性研究。
对 ESPRIT 和 SILCAAT 研究的对照组中的 3012 例患者（20317 人年）进行前瞻性随访。我们使用 Cox 回归来确定 CD4(+) 指标（最新、基线和最低 CD4(+) 细胞计数、最新 CD4(+)%、CD4(+) 计数低于特定阈值和 CD4(+) 斜率的时间）是否可独立预测全因死亡率、非艾滋病死亡、非艾滋病（心血管、肝脏、肾脏和非艾滋病恶性肿瘤）和艾滋病事件。计算了每个模型的赤池信息量准则（AIC）。然后，对具有统计学意义的指标（P<0.05），进一步进行最新 CD4(+) 细胞计数的调整。
非艾滋病死亡的发生率高于艾滋病死亡[比率比：6.48，95%置信区间（CI）5.1-8.1]，非艾滋病事件的发生率也更高[比率比：1.72，95%CI 1.65-1.79]。最新 CD4(+) 细胞计数可强烈预测死亡率降低的风险（每增加一个对数 2 升高的危险比：0.48，95%CI 0.43-0.54），所有指标中 AIC 最低。在进一步调整最新 CD4(+) 细胞计数后，七个访视期间的 CD4(+) 斜率是全因（斜率<-10 个细胞/微升/月与 0 +/- 10：3.04，95%CI 1.98-4.67）和非艾滋病死亡（斜率<-10 个细胞/微升/月与 0 +/- 10：2.62，95%CI 1.62-4.22）的唯一独立预测因素。最新 CD4(+) 细胞计数（每对数 2 升高）是所有四个终点的最佳预测指标，预测肝脏（危险比 0.46，95%CI 0.33-0.63）和肾脏事件（危险比 0.39，95%CI 0.21-0.70），但不预测心血管事件（危险比 1.05，95%CI 0.77-1.43）或非艾滋病癌症（危险比 0.78，95%CI 0.59-1.03）。
最新 CD4(+) 细胞计数是严重终点的最佳预测指标。CD4(+) 斜率可独立预测全因和非艾滋病死亡。
