HIV相关疾病和结核病重症患者的6个月生存率：一项回顾性研究。
Six-month survival of critically ill patients with HIV-related disease and tuberculosis: a retrospective study.
作者信息
Pecego Ana Carla, Amancio Rodrigo T, Ribeiro Camila, Mesquita Emersom C, Medeiros Denise M, Cerbino José, Grinsztejn Beatriz, Bozza Fernando A, Japiassu Andre M
机构信息
Intensive Care Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil.
STD/AIDS Clinical Research Laboratory, National Institute of Infectious Diseases (NIID), Av Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21045-900, Brazil.
出版信息
BMC Infect Dis. 2016 Jun 10;16:270. doi: 10.1186/s12879-016-1644-6.
BACKGROUND
Tuberculosis is one of the leading causes of death from infectious diseases worldwide, mainly after the human immunodeficiency virus (HIV) epidemics. Patient with HIV-related illness are more likely to present with severe TB due to immunosuppression. Very few studies have explored HIV/TB co-infection in critically ill patients. The goal of this study was to analyze factors associated with long-term mortality in critically ill patient with HIV-related disease coinfected with TB.
METHODS
We conducted a retrospective study in an infectious disease reference center in Brazil that included all patient with HIV-related illness admitted to the ICU with laboratory-confirmed tuberculosis from March 2007 until June 2012. Clinical and laboratory variables were analyzed based on six-month survival.
RESULTS
Forty-four patients with HIV-related illness with a confirmed diagnosis of tuberculosis were analyzed. The six-month mortality was 52 % (23 patients). The main causes of admission were respiratory failure (41 %), severe sepsis/septic shock (32 %) and coma/torpor (14 %). The median time between HIV diagnosis and ICU admission was 5 (1-60) months, and 41 % of patients received their HIV infection diagnosis ≤ 30 days before admission. The median CD4 count was 72 (IQR: 23-136) cells/mm(3). The clinical presentation was pulmonary tuberculosis in 22 patients (50 %) and disseminated TB in 20 patients (45.5 %). No aspect of TB diagnosis or treatment was different between survivors and nonsurvivors. Neurological dysfunction was more prevalent among nonsurvivors (43 % vs. 14 %, p = 0.04). The nadir CD4 cell count lower than 50 cells/mm(3) was independently associated with Six-month mortality (hazard ratio 4.58 [1.64-12.74], p < 0.01), while HIV diagnosis less than three months after positive serology was protective (hazard ratio 0.27, CI 95 % [0.10-0.72], p = 0.01).
CONCLUSION
The Six-month mortality of HIV critically ill patients with TB coinfection is high and strongly associated with the nadir CD4 cell count less than 50 cels/mm(3).
背景
结核病是全球主要的传染病致死原因之一，仅次于人类免疫缺陷病毒（HIV）流行。患有HIV相关疾病的患者由于免疫抑制更容易出现严重结核病。很少有研究探讨重症患者中的HIV/TB合并感染情况。本研究的目的是分析合并感染结核病的HIV相关疾病重症患者长期死亡的相关因素。
方法
我们在巴西一家传染病参考中心进行了一项回顾性研究，纳入了2007年3月至2012年6月期间入住重症监护病房且实验室确诊结核病的所有HIV相关疾病患者。基于六个月生存率分析临床和实验室变量。
结果
分析了44例确诊结核病的HIV相关疾病患者。六个月死亡率为52%（23例患者）。主要入院原因是呼吸衰竭（41%）、严重脓毒症/脓毒性休克（32%）和昏迷/昏睡（14%）。HIV诊断至入住重症监护病房的中位时间为5（1 - 60）个月，41%的患者在入院前≤30天被诊断出HIV感染。CD4细胞计数中位数为72（四分位间距：23 - 136）个细胞/mm³。临床表现为22例患者（50%）为肺结核，20例患者（45.5%）为播散性结核病。幸存者和非幸存者在结核病诊断或治疗方面没有差异。非幸存者中神经功能障碍更为普遍（43%对14%，p = 0.04）。CD4细胞计数最低点低于50个细胞/mm³与六个月死亡率独立相关（风险比4.58 [1.64 - 12.74]，p < 0.01），而血清学阳性后不到三个月诊断出HIV具有保护作用（风险比0.27，95%置信区间[0.10 - 0.72]，p = 0.01）。
结论
合并感染结核病的HIV重症患者六个月死亡率很高，且与CD4细胞计数最低点低于50个细胞/mm³密切相关。
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