Predictors of cardiac morbidity and related mortality in children with acquired immunodeficiency syndrome

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• 作者：Inas Al-Attar ; E. John Orav ; Vernat Exil ; Sarah A. Vlach ; Steven E. Lipshultz
• 关键词：ACC/AHA Guidelines ; echocardiography ; imaging
• 刊名：Journal of the American College of Cardiology
• 出版年：2003
• 出版时间：7 May 2003
• 年：2003
• 卷：41
• 期：9
• 页码：1598-1605
• 全文大小：127 K

文摘

The aim of this study was to determine the prevalence of cardiovascular dysfunction and its predictors in children with acquired immunodeficiency syndrome (AIDS).

Background

Cardiovascular manifestations are common among children with AIDS but may be clinically occult.

Methods

We reviewed the medical records, echocardiograms, electrocardiograms, and Holter monitor studies of 68 children with AIDS. We tested clinical and demographic characteristics at the time of AIDS diagnosis for their ability to predict serious cardiac events, death, and cardiac death.

Results

The median time from AIDS diagnosis to death or end of follow-up was 1.0 year (range, 1 week to 7.9 years). Nineteen patients (28 % ) experienced serious cardiac events after AIDS diagnosis. Of 43 patients who died, 15 (35 % ) had cardiac dysfunction. Multivariable analyses revealed that recurrent bacterial infections, wasting, encephalopathy, male gender, and an earlier year of AIDS diagnosis were predictors of serious cardiac events (relative risk [RR] = 9.3, 6.9, 4.7, 4.1, and 0.76, respectively, p < 0.05). Wasting, encephalopathy, a low age-adjusted CD4 count, a low age-adjusted immunoglobulin G (IgG) level, and an earlier year of AIDS diagnosis increased the risk of all-cause mortality (RR = 8.9, 5.1, 2.7, 0.82, and 0.8, respectively, p ≤ 0.02). Male gender, a low age-adjusted CD4 count, and a low age-adjusted IgG level increased the risk for cardiac death (RR = 16.9, 4.2, and 0.68, respectively, p ≤ 0.05).

Conclusions

Serious cardiac events and cardiac death are common among children with AIDS. Factors such as recurrent bacterial infections, wasting, encephalopathy, male gender, low CD4 and IgG levels, and an earlier year at AIDS diagnosis may identify high-risk patients.