Jacobson M A, Liu R C, Davies D, Cohen P T
Department of Medicine, University of California, San Francisco, USA.
Arch Intern Med. 1997 Sep 8;157(16):1825-31.
Neutropenia is common in patients with human immunodeficiency virus (HIV) disease. However, the degree of risk for serious bacterial infections associated with various levels of neutropenia in patients with HIV disease is not well defined.
A retrospective analysis of databases containing demographic information for patients attending the San Francisco General Hospital HIV outpatient clinic, test results reported by the hospital's clinical laboratory, and the San Francisco General Hospital inpatient International Classification of Diseases, Ninth Revision (ICD-9) hospital discharge diagnosis codes from October 1, 1992, through November 30, 1993. Risk window time periods were defined, encompassing dates that consecutive absolute neutrophil counts (ANCs) occurred in a single ANC stratum. One risk window at the lowest ANC stratum for each patient was analyzed for hospitalizations with ICD-9 codes indicating bacterial infections. A 5% random sample of medical records was reviewed for end point validation.
Codes from ICD-9 had 98% and 96% positive and negative predictive values, respectively, for meeting National Institute of Allergy and Infectious Diseases Division of AIDS [acquired immunodeficiency syndrome] clinical trial end point definitions for bacterial infections. Among 2047 evaluable patients, a significant increase in the incidence of hospitalization for serious bacterial infections was observed for those in the ANC strata of 500 to 749 X 10(6)/L and below. The 95% confidence intervals for the incidence of hospitalization associated with each ANC stratum below 500 X 10(6)/L did not overlap with that for any stratum of 750 X 10(6)/L or higher (22-117 vs 0.4-19 patient hospitalizations per 10000 days at risk, respectively). A multivariate analysis revealed only the severity and duration of neutropenia and black race to be significant end point predictors.
Among 2047 patients with HIV disease, significantly higher risks of hospitalization for bacterial infections were associated with ANCs lower than 750 X 10(6)/L, especially for ANCs lower than 500 X 10(6)/L.
中性粒细胞减少在人类免疫缺陷病毒（HIV）病患者中很常见。然而，HIV病患者中与不同程度中性粒细胞减少相关的严重细菌感染风险程度尚未明确界定。
对数据库进行回顾性分析，这些数据库包含旧金山综合医院HIV门诊患者的人口统计学信息、医院临床实验室报告的检测结果以及1992年10月1日至1993年11月30日期间旧金山综合医院住院患者的国际疾病分类第九版（ICD - 9）出院诊断代码。定义了风险窗口期，涵盖单个绝对中性粒细胞计数（ANC）分层中连续ANC出现的日期。分析了每位患者最低ANC分层中的一个风险窗口期内伴有表明细菌感染的ICD - 9代码的住院情况。对5%的病历随机样本进行审查以验证终点。
ICD - 9代码对于符合美国国立过敏与传染病研究所艾滋病司[获得性免疫缺陷综合征]临床试验细菌感染终点定义的阳性预测值和阴性预测值分别为98%和96%。在2047例可评估患者中，ANC分层为500至749×10⁶/L及以下的患者，严重细菌感染住院发生率显著增加。低于500×10⁶/L的每个ANC分层的住院发生率的95%置信区间与750×10⁶/L或更高的任何分层的住院发生率的95%置信区间不重叠（分别为每10000天风险中22 - 117例与0.4 - 19例患者住院）。多变量分析显示只有中性粒细胞减少的严重程度和持续时间以及黑人种族是显著的终点预测因素。
在2047例HIV病患者中，ANC低于750×10⁶/L，尤其是低于500×10⁶/L时，细菌感染住院风险显著更高。
