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Raised Venous Lactate and Markers of Intestinal Translocation Are Associated With Mortality Among In-Patients With HIV-Associated TB in Rural South Africa.

Title: Raised Venous Lactate and Markers of Intestinal Translocation Are Associated With Mortality Among In-Patients With HIV-Associated TB in Rural South Africa.
Authors: Subbarao, S
Wilkinson, KA
van Halsema, CL
Rao, SS
Boyles, T
Utay, NS
Wilkinson, RJ
Meintjes, G
Item Type: Journal Article
Abstract: Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.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/mm3), 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.
Issue Date: 1-Dec-2015
Date of Acceptance: 8-Jul-2015
URI: http://hdl.handle.net/10044/1/28226
DOI: https://dx.doi.org/10.1097/QAI.0000000000000763
ISSN: 0894-9255
Publisher: Lippincott, Williams & Wilkins
Start Page: 406
End Page: 413
Journal / Book Title: Journal of Acquired Immune Deficiency Syndromes
Volume: 70
Issue: 4
Copyright Statement: © 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.
Publication Status: Published
Appears in Collections:Department of Medicine
Faculty of Medicine



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