Cunningham W E, Rana H M, Shapiro M F, Hays R D
Department of Medicine, School of Medicine, University of California, Los Angeles 90095, USA.
J Clin Epidemiol. 1997 Jul;50(7):829-35. doi: 10.1016/s0895-4356(97)00061-9.
Studies of health care outcomes and clinical decision making for people with HIV disease depend on CD4 cell count data to accurately assess the stage of disease. The possibility of obtaining reliable and valid data from self-reported CD4 counts is an unexplored source of potentially important, cost-effective information for these purposes. We examined the extent of agreement of self-reported CD4 counts with medical record CD4 among 120 patients (95% male, 69% white, 5% injection drug users) hospitalized with HIV-related illness at seven Los Angeles area hospitals. Average record and report CD4 counts did not differ significantly, and record and report CD4 counts were highly correlated (product moment correlation of 0.84, intraclass correlation of 0.82). Agreement between self-reports and medical records varied by CD4 level: at higher levels of CD4, the differences between self-reports and medical records tended to be larger, with self-reports yielding upwardly biased estimates compared to the medical records. These findings suggest that self-report CD4 data may provide clinically adequate estimates of true CD4 counts. The study needs to be replicated in other populations, notably those with larger numbers of subjects who are female, of minority ethnicity, or injection drug users.
对艾滋病患者的医疗保健结果及临床决策的研究依赖于CD4细胞计数数据来准确评估疾病阶段。从自我报告的CD4计数中获取可靠且有效的数据，对于这些目的而言，是一个尚未探索的潜在重要且具有成本效益的信息来源。我们调查了洛杉矶地区七家医院120名因艾滋病相关疾病住院的患者（95%为男性，69%为白人，5%为注射吸毒者）自我报告的CD4计数与病历中CD4计数的一致程度。病历记录的CD4计数与自我报告的CD4计数平均值无显著差异，且两者高度相关（积差相关系数为0.84，组内相关系数为0.82）。自我报告与病历之间的一致性因CD4水平而异：在较高的CD4水平时，自我报告与病历之间的差异往往更大，自我报告得出的估计值相较于病历有向上的偏差。这些发现表明，自我报告的CD4数据可能为真实的CD4计数提供临床上足够的估计。该研究需要在其他人群中重复进行，尤其是女性、少数族裔或注射吸毒者数量更多的人群。
