| Risk factors for fatality in HIV-infected patients with dideoxynucleoside-induced severe hyperlactataemia or lactic acidosis. | |
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MedLine Citation:
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PMID: 21447871 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Lactic acidosis (LA) and severe hyperlactataemia (HL) are infrequent but serious complications of antiretroviral therapy that have been associated with a high fatality rate. METHODS: In a multinational retrospective cohort study, LA was defined as arterial blood pH<7.35, bicarbonate <20 mmol/l and lactate above normal, and HL as confirmed blood lactate >5 mmol/l. Logistic regression was used to identify factors associated with fatality. Sensitivity and specificity of different case definitions as predictors of death were compared. RESULTS: The overall case-fatality rate was 19/110 (17.3%), but among acidotic patients it was 33% (16/49 cases). There were 10 asymptomatic patients and none of them died as a consequence of the event. The median lactate for fatal, non-fatal and all patients was 8.3 mmol/l (IQR 7.2-13.1), 6.4 mmol/l (IQR 5.4-7.8) and 6.7 mmol/l (IQR 5.5-8.1), respectively. After adjusting for age and current CD4(+) T-cell count, lactate >7 mmol/l (OR 6.27, 95% CI 1.13-34.93), blood bicarbonate <12 mmol/l (OR 10.02 relative to >18 mmol/l, 95% CI 1.33-75.65) and concurrent opportunistic infections (OR 8.69, 95% CI 1.45-52.22) were independently associated with case fatality. Blood lactate >7 mmol/l showed a sensitivity of 84% for fatality with a specificity of 60%, whereas bicarbonate <12 mmol/l showed a better specificity (85%) but a poorer sensitivity (42%). Bicarbonate <18 mmol/l appears to be as good as lactate <7 mmol/l at predicting death (sensitivity 90% and specificity 54%). CONCLUSIONS: Our data suggest that blood lactate >7 mmol/l and blood bicarbonate <18 mmol/l appear to predict death and might help clinicians in selecting patients who may benefit from more intense monitoring. |
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Authors:
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Alejandro Arenas-Pinto; Alison Grant; Krishnan Bhaskaran; Andrew Copas; Andrew Carr; Signe W Worm; Esteban Martinez; Peter Reiss; David Dunn; Rainer Weber; Jennifer Hoy; Ian Weller; |
Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: Antiviral therapy Volume: 16 ISSN: 2040-2058 ISO Abbreviation: - Publication Date: 2011 |
Date Detail:
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Created Date: 2011-3-30 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9815705 Medline TA: Antivir Ther Country: - |
Other Details:
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Languages: ENG Pagination: 219-226 Citation Subset: - |
Affiliation:
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Centre for Sexual Health & HIV Research, University College London, London, UK. A.Arenas-Pinto@ucl.ac.uk. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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