Does an index composed of clinical data reflect effects of inflammation, coagulation, and monocyte activation on mortality among those aging with HIV?

Does an index composed of clinical data reflect effects of inflammation, coagulation, and monocyte activation on mortality among those aging with HIV?

MedLine Citation:	PMID: 22337823 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: When added to age, CD4 count and human immunodeficiency virus type 1 (HIV-1) RNA alone (Restricted Index), hemoglobin, FIB-4 Index, hepatitis C virus (HCV), and estimated glomerular filtration rate improve prediction of mortality. Weighted and combined, these 7 routine clinical variables constitute the Veterans Aging Cohort Study (VACS) Index. Because nonroutine biomarkers of inflammation (interleukin 6 [IL-6]), coagulation (D-dimer), and monocyte activation (sCD14) also predict mortality, we test the association of these indices and biomarkers with each other and with mortality. METHODS: Samples from 1302 HIV-infected veterans on antiretroviral therapy were analyzed. Indices were calculated closest to date of collection. We calculated Spearman correlations stratified by HIV-1 RNA and HCV status and measured association with mortality using C statistics and net reclassification improvement (NRI). RESULTS: Of 1302 subjects, 915 had HIV-1 RNA <500 copies/mL and 154 died. The VACS Index was more correlated with IL-6, D-dimer, and sCD14 than the Restricted Index (P < .001). It was also more predictive of mortality (C statistic, 0.76; 95% confidence interval [CI], .72-.80) than any biomarker (C statistic, 0.66-0.70) or the Restricted Index (C statistic, 0.71; 95% CI, .67-.75). Compared to the Restricted Index alone, NRI resulted from incremental addition of VACS Index components (10%), D-dimer (7%), and sCD14 (4%), but not from IL-6 (0%). CONCLUSIONS: Among HIV-infected individuals, independent of CD4, HIV-1 RNA, and age, hemoglobin and markers of liver and renal injury are associated with inflammation. Addition of D-dimer and sCD14, but not IL-6, improves the predictive accuracy of the VACS Index for mortality.

Authors:	Amy C Justice; Matthew S Freiberg; Russ Tracy; Lew Kuller; Janet P Tate; Matthew Bidwell Goetz; David A Fiellin; Gary J Vanasse; Adeel A Butt; Maria C Rodriguez-Barradas; Cynthia Gibert; Kris Ann Oursler; Steven G Deeks; Kendall Bryant;
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Publication Detail:	Type: Journal Article; Research Support, N.I.H., Extramural Date: 2012-02-15
Journal Detail:	Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 54 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2012 Apr
Date Detail:	Created Date: 2012-03-09 Completed Date: 2012-07-09 Revised Date: 2013-05-20
Medline Journal Info:	Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States
Other Details:	Languages: eng Pagination: 984-94 Citation Subset: IM
Affiliation:	Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA. amy.justice2@va.gov
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MeSH Terms
Descriptor/Qualifier:	Adult Aged Aged, 80 and over Aging* Antigens, CD14 / blood* Biological Markers / blood* Female Fibrin Fibrinogen Degradation Products / analysis* HIV Infections / diagnosis, mortality, pathology HIV-1 / immunology, pathogenicity Humans Interleukin-6 / blood* Male Middle Aged Prognosis Survival Analysis
Grant Support
ID/Acronym/Agency:	K23 AG024896/AG/NIA NIH HHS; R01-AG029154/AG/NIA NIH HHS; R01-HL090342/HL/NHLBI NIH HHS; R01-HL095136/HL/NHLBI NIH HHS; RCI-HL100347/HL/NHLBI NIH HHS; T32 ES07069/ES/NIEHS NIH HHS; U10-AA13566/AA/NIAAA NIH HHS
Chemical
Reg. No./Substance:	0/Antigens, CD14; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/Interleukin-6; 0/fibrin fragment D
Comments/Corrections
Comment In:	Clin Infect Dis. 2012 Sep;55(5):750-1; author reply 751-2 [PMID: 22670040 ]

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