Raised Venous Lactate and Markers of Intestinal Translocation Are Associated With Mortality Among In-Patients With HIV-Associated TB in Rural South Africa. (1st December 2015)

• Record Type: Journal Article
• Authors: Subbarao, Sathyavani; Wilkinson, Katalin A.; van Halsema, Clare L.; Rao, Suhasini Subba; Boyles, Tom; Utay, Netanya S.; Wilkinson, Robert J.; Meintjes, Graeme
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 70:Number 4(2015)
• Publication Date: 2015-12-01
• Subjects: human immunodeficiency virus -- tuberculosis -- mortality -- lactate -- translocation -- lipopolysaccaride; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000000763
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Introduction: Case fatality among in-patients with HIV-associated tuberculosis (HIV-TB) in Africa is high. We investigated the factors associated with mortality in a rural South African hospital. Methods: This was a prospective observational study of HIV-TB in-patients, with death by 8 weeks the endpoint. Results: Of 99 patients (median CD4 count 72 cells/mm 3 ), 32 (32%) died after median 8-day TB treatment. TB was diagnosed microbiologically in 75/99 and clinico-radiologically in 24, with no mortality difference between these groups [31% versus 38% ( P = 0.53)]. Median venous lactate was 5.5 mmol/L (interquartile range 3.9–6.2) in those who died and 3.1 mmol/L (interquartile range 2.2–4.1) in survivors ( P < 0.001). In multivariable analysis, lactate ≥4 mmol/L [adjusted odds ratio (aOR) 9.8, 95% confidence interval (CI): 3.0 to 32.2], Glasgow Coma Score <15 (aOR 6.6, 95% CI: 1.5 to 29.6), CD4 count <50 cells per cubic millimeter (aOR 5.5, 95% CI: 1.6 to 18.5), and age ≥50 (aOR 7.7, 95% CI: 1.2 to 46.9) independently predicted death. In a nested case–control study, comparing those who died versus CD4-matched survivors, median plasma lipopolysaccharide concentrations were 93 and 57 pg/mL ( P = 0.026) and intestinal fatty acid–binding protein, 132 and 0 pg/mL ( P = 0.002). Conclusions: Mortality was high and predicted by elevated lactate, likely reflecting a sepsis-syndrome secondary to TB or bacterial coinfection with intestinal barrier dysfunction appearing to contribute. Abstract : Supplemental Digital Content is Available in the Text.