Nacher Mathieu, Drak Alsibai Kinan, Valdes Audrey, Blaizot Romain, Abboud Philippe, Demar Magalie, Djossou Félix, Epelboin Loïc, Misslin Caroline, Ntab Balthazar, Adenis Antoine, Couppié Pierre
CIC INSERM 1424, Centre Hospitalier AndreeRosemon Cayenne, 97300 Cayenne, France.
DFR Santé, Université de Guyane, 97300 Cayenne, France.
J Fungi (Basel). 2020 Nov 30;6(4):326. doi: 10.3390/jof6040326.
Identifying prognostic factors is important in order to guide the choice of first-line therapy for disseminated histoplasmosis. Our objective was to identify factors associated with death among a cohort of 330 patients compiled over 34 years of clinical practice in French Guiana. Survival analysis was performed with death as the failure event and date of symptom onset as the origin event. Incidence rates were and Cox proportional hazards models were computed. Overall, 330 HIV-infected patients with disseminated histoplasmosis were included in the analysis, with 126 deaths occurring. One-quarter of all patients died within 6 months of the first symptoms. Patients with dyspnea, renal failure, arterial blood pressure < 90 mmHG, and a WHO performance score > 2 had a greater incidence of death. Bivariate analyses showed that patients with increased LDH, low hemoglobin, low serum protein, low CD4 counts, and low platelets tended to have a greater incidence of death. After adjusting for potential confounders, patients with dyspnea, a WHO performance score > 2, serum protein < 60 g/L, and hemoglobin < 8.9 g/dL had an increased risk of dying. The interaction terms showed that patients treated with liposomal amphotericin B had a marked reduction in death among patients with renal failure; among renal failure patients, the elevation of LDH was associated with a significant risk of death.
识别预后因素对于指导播散性组织胞浆菌病一线治疗方案的选择至关重要。我们的目标是在法属圭亚那34年临床实践中收集的330例患者队列中识别与死亡相关的因素。以死亡为失败事件，症状出现日期为起始事件进行生存分析。计算发病率和Cox比例风险模型。总体而言，330例播散性组织胞浆菌病的HIV感染患者纳入分析，其中126例死亡。所有患者中有四分之一在出现首发症状后6个月内死亡。出现呼吸困难、肾衰竭、动脉血压<90 mmHg以及世界卫生组织体能状态评分>2的患者死亡发生率更高。双变量分析显示，乳酸脱氢酶升高、血红蛋白低、血清蛋白低、CD4细胞计数低以及血小板低的患者死亡发生率往往更高。在对潜在混杂因素进行校正后，出现呼吸困难、世界卫生组织体能状态评分>2、血清蛋白<60 g/L以及血红蛋白<8.9 g/dL的患者死亡风险增加。交互项显示，接受脂质体两性霉素B治疗的肾衰竭患者死亡显著减少；在肾衰竭患者中，乳酸脱氢酶升高与显著的死亡风险相关。
