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Abstract：
BACKGROUND: This study\'s objective was to investigate the predictors for severe anemia, severe leukopenia, and severe thrombocytopenia when amphotericin B deoxycholate-based induction therapy is used in HIV-infected patients with talaromycosis.
METHODS: A total of 170 HIV-infected patients with talaromycosis were enrolled from January 1st, 2019, to September 30th, 2020.
RESULTS: Approximately 42.9%, 20.6%, and 10.6% of the enrolled patients developed severe anemia, severe leukopenia, and severe thrombocytopenia, respectively. Baseline hemoglobin level < 100 g/L (OR = 5.846, 95% CI: 2.765 ~ 12.363), serum creatinine level > 73.4 µmol/L (OR = 2.573, 95% CI: 1.157 ~ 5.723), AST/ALT ratio > 1.6 (OR = 2.479, 95% CI: 1.167 ~ 5.266), sodium level ≤ 136 mmol/liter (OR = 4.342, 95% CI: 1.747 ~ 10.789), and a dose of amphotericin B deoxycholate > 0.58 mg/kg/d (OR = 2.504, 95% CI:1.066 ~ 5.882) were observed to be independent risk factors associated with the development of severe anemia. Co-infection with tuberculosis (OR = 3.307, 95% CI: 1.050 ~ 10.420), and platelet level (per 10 × 109 /L) (OR = 0.952, 95% CI: 0.911 ~ 0.996) were shown to be independent risk factors associated with the development of severe leukopenia. Platelet level < 100 × 109 /L (OR = 2.935, 95% CI: 1.075 ~ 8.016) was identified as the independent risk factor associated with the development of severe thrombocytopenia. There was no difference in progression to severe anemia, severe leukopenia, and severe thrombocytopenia between the patients with or without fungal clearance at 2 weeks. 10 mg on the first day of amphotericin B deoxycholate was calculated to be independent risk factors associated with the development of severe anemia (OR = 2.621, 95% CI: 1.107 ~ 6.206). The group receiving a starting amphotericin B dose (10 mg, 20 mg, daily) exhibited the highest fungal clearance rate at 96.3%, which was significantly better than the group receiving a starting amphotericin B dose (5 mg, 10 mg, 20 mg, daily) (60.9%) and the group receiving a starting amphotericin B dose (5 mg, 15 mg, and 25 mg, daily) (62.9%).
CONCLUSIONS: The preceding findings reveal risk factors for severe anemia, severe leukopenia, and severe thrombocytopenia. After treatment with Amphotericin B, these severe adverse events are likely unrelated to fungal clearance at 2 weeks. Starting amphotericin B deoxycholate at a dose of 10 mg on the first day may increase the risk of severe anemia but can lead to earlier fungal clearance.
BACKGROUND: ChiCTR1900021195. Registered 1 February 2019.
METHODS: A total of 170 HIV-infected patients with talaromycosis were enrolled from January 1st, 2019, to September 30th, 2020.
RESULTS: Approximately 42.9%, 20.6%, and 10.6% of the enrolled patients developed severe anemia, severe leukopenia, and severe thrombocytopenia, respectively. Baseline hemoglobin level < 100 g/L (OR = 5.846, 95% CI: 2.765 ~ 12.363), serum creatinine level > 73.4 µmol/L (OR = 2.573, 95% CI: 1.157 ~ 5.723), AST/ALT ratio > 1.6 (OR = 2.479, 95% CI: 1.167 ~ 5.266), sodium level ≤ 136 mmol/liter (OR = 4.342, 95% CI: 1.747 ~ 10.789), and a dose of amphotericin B deoxycholate > 0.58 mg/kg/d (OR = 2.504, 95% CI:1.066 ~ 5.882) were observed to be independent risk factors associated with the development of severe anemia. Co-infection with tuberculosis (OR = 3.307, 95% CI: 1.050 ~ 10.420), and platelet level (per 10 × 109 /L) (OR = 0.952, 95% CI: 0.911 ~ 0.996) were shown to be independent risk factors associated with the development of severe leukopenia. Platelet level < 100 × 109 /L (OR = 2.935, 95% CI: 1.075 ~ 8.016) was identified as the independent risk factor associated with the development of severe thrombocytopenia. There was no difference in progression to severe anemia, severe leukopenia, and severe thrombocytopenia between the patients with or without fungal clearance at 2 weeks. 10 mg on the first day of amphotericin B deoxycholate was calculated to be independent risk factors associated with the development of severe anemia (OR = 2.621, 95% CI: 1.107 ~ 6.206). The group receiving a starting amphotericin B dose (10 mg, 20 mg, daily) exhibited the highest fungal clearance rate at 96.3%, which was significantly better than the group receiving a starting amphotericin B dose (5 mg, 10 mg, 20 mg, daily) (60.9%) and the group receiving a starting amphotericin B dose (5 mg, 15 mg, and 25 mg, daily) (62.9%).
CONCLUSIONS: The preceding findings reveal risk factors for severe anemia, severe leukopenia, and severe thrombocytopenia. After treatment with Amphotericin B, these severe adverse events are likely unrelated to fungal clearance at 2 weeks. Starting amphotericin B deoxycholate at a dose of 10 mg on the first day may increase the risk of severe anemia but can lead to earlier fungal clearance.
BACKGROUND: ChiCTR1900021195. Registered 1 February 2019.
摘要：
背景：本研究的目的是探讨严重贫血的预测因素，严重的白细胞减少症,和严重的血小板减少当两性霉素B脱氧胆酸诱导治疗用于HIV感染的塔拉真菌病患者。
方法：从1月1日起，共纳入170例HIV感染的塔拉真菌病患者，2019年9月30日,2020年。
结果：大约42.9%，20.6%,10.6%的患者出现严重贫血,严重的白细胞减少症,和严重的血小板减少症,分别。基线血红蛋白水平<100g/L(OR=5.846,95%CI:2.765~12.363),血清肌酐水平>73.4µmol/L（OR=2.573，95％CI：1.157〜5.723），AST/ALT比值>1.6(OR=2.479,95%CI:1.167~5.266),钠水平≤136mmol/L（OR=4.342，95%CI：1.747~10.789），两性霉素B脱氧胆酸盐剂量>0.58mg/kg/d（OR=2.504，95％CI：1.066〜5.882）是与严重贫血发展相关的独立危险因素。合并感染肺结核(OR=3.307,95%CI:1.050~10.420),血小板水平（每10×109/L）（OR=0.952，95％CI：0.911〜0.996）是与严重白细胞减少症发展相关的独立危险因素。血小板水平<100×109/L(OR=2.935,95%CI:1.075~8.016)是发生严重血小板减少的独立危险因素。严重贫血的进展没有差异，严重的白细胞减少症,2周有或没有真菌清除的患者之间的严重血小板减少。在第一天服用10mg的两性霉素B脱氧胆酸盐是严重贫血发生的独立危险因素（OR=2.621，95％CI：1.107〜6.206）。接受两性霉素B起始剂量（10mg，20毫克，每日)表现出最高的真菌清除率，为96.3%，显着优于接受起始两性霉素B剂量的组（5mg，10毫克，20毫克，每日）（60.9％）和接受起始两性霉素B剂量（5mg，15毫克，和25毫克，每日）（62.9%）。
结论：上述发现揭示了严重贫血的危险因素，严重的白细胞减少症,和严重的血小板减少症.用两性霉素B治疗后，这些严重不良事件可能与2周时的真菌清除无关.在第一天以10mg的剂量开始两性霉素B脱氧胆酸盐可能会增加严重贫血的风险，但会导致更早的真菌清除。
背景：ChiCTR1900021195。2019年2月1日注册。
方法：从1月1日起，共纳入170例HIV感染的塔拉真菌病患者，2019年9月30日,2020年。
结果：大约42.9%，20.6%,10.6%的患者出现严重贫血,严重的白细胞减少症,和严重的血小板减少症,分别。基线血红蛋白水平<100g/L(OR=5.846,95%CI:2.765~12.363),血清肌酐水平>73.4µmol/L（OR=2.573，95％CI：1.157〜5.723），AST/ALT比值>1.6(OR=2.479,95%CI:1.167~5.266),钠水平≤136mmol/L（OR=4.342，95%CI：1.747~10.789），两性霉素B脱氧胆酸盐剂量>0.58mg/kg/d（OR=2.504，95％CI：1.066〜5.882）是与严重贫血发展相关的独立危险因素。合并感染肺结核(OR=3.307,95%CI:1.050~10.420),血小板水平（每10×109/L）（OR=0.952，95％CI：0.911〜0.996）是与严重白细胞减少症发展相关的独立危险因素。血小板水平<100×109/L(OR=2.935,95%CI:1.075~8.016)是发生严重血小板减少的独立危险因素。严重贫血的进展没有差异，严重的白细胞减少症,2周有或没有真菌清除的患者之间的严重血小板减少。在第一天服用10mg的两性霉素B脱氧胆酸盐是严重贫血发生的独立危险因素（OR=2.621，95％CI：1.107〜6.206）。接受两性霉素B起始剂量（10mg，20毫克，每日)表现出最高的真菌清除率，为96.3%，显着优于接受起始两性霉素B剂量的组（5mg，10毫克，20毫克，每日）（60.9％）和接受起始两性霉素B剂量（5mg，15毫克，和25毫克，每日）（62.9%）。
结论：上述发现揭示了严重贫血的危险因素，严重的白细胞减少症,和严重的血小板减少症.用两性霉素B治疗后，这些严重不良事件可能与2周时的真菌清除无关.在第一天以10mg的剂量开始两性霉素B脱氧胆酸盐可能会增加严重贫血的风险，但会导致更早的真菌清除。
背景：ChiCTR1900021195。2019年2月1日注册。
