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Vol. 44. Issue 5.
Pages 283-293 (June - July 2020)
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Vol. 44. Issue 5.
Pages 283-293 (June - July 2020)
Original article
DOI: 10.1016/j.medine.2019.02.015
Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era
Epidemiología y pronóstico de los pacientes con VIH ingresados en la UCI en la era de tratamiento antirretroviral de gran actividad actual
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P. Vidal-Cortésa,
Corresponding author
pablo.vidal.cortes@sergas.es

Corresponding author.
, L.A. Álvarez-Rochab, P. Fernández-Ugidosa, M.A. Pérez-Velosoa, I.M. Suárez-Paulc, A. Virgós-Pedreirad, S. Pértega-Díaze, Á.C. Castro-Iglesiasf
a Intensive Care Unit, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Spain
b Intensive Care Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Spain
c Intensive Care Unit, Hospital San Juan de Dios, Córdoba, Spain
d Intensive Care Unit, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Spain
e Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña, Spain
f Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INBIC) – Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña, Spain
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Tables (4)
Table 1. Baseline characteristics of patients.
Table 2. Comparison based on year of admission.
Table 3. Comparison between patients who receive HAART and those who not (pre-ICU admission and during ICU stay).
Table 4. Variables related to hospital mortality. Univariate and multivariate logistic regression analysis.
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Additional material (1)
Abstract
Purpose

To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors.

Methods

A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann–Whitney U-test or Kruskal–Wallis test, assuming an alpha level=0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time.

Results

A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2–38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95%CI: 1.30–10.20; p=0.01), moderate–severe liver disease (OR 5.65, 95%CI: 1.11–28.87; p=0.04) and the APACHE II score (OR 1.14, 95%CI: 1.04–1.26; p<0.01) and SOFA score at 72h (OR 1.19, 95%CI: 1.02–1.40; p=0.03) maintained a statistically significant relationship with hospital mortality.

Conclusions

Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition.

Keywords:
HIV
HAART
Prognosis
Resumen
Objetivos

Describir la epidemiología de la patología crítica en el paciente infectado por VIH durante la era de tratamiento antirretroviral de gran actividad actual y encontrar predictores de mortalidad hospitalaria.

Métodos

Estudio observacional, retrospectivo y longitudinal que incluye pacientes infectados por VIH adultos ingresados en las UCI de hospitales de Galicia, entre el 1 de enero de 2000 y el 31 de diciembre de 2014. Analizamos variables demográficas y relacionadas con la infección por el VIH, comorbilidades, puntuaciones de gravedad, motivo de ingreso y necesidad de soporte de órganos. Empleamos la prueba de la Chi-cuadrado para comparar las variables categóricas y las pruebas de la T-Student, U de Mann-Whitney o H de Kruskal-Wallis para las variables continuas, asumiendo un error α=0,05. Utilizamos la regresión logística multivariante para calcular la OR de la asociación con la mortalidad hospitalaria. Aplicamos análisis de regresión de joinpoint para estudiar la tendencia temporal de mortalidad.

Resultados

Incluimos 283 episodios. La mortalidad hospitalaria fue del 32,9% (IC 95%=21,2-38,5%). El ingreso no procedente de Urgencias (OR 3,64; IC 95%= 1,30-10,20; p=0,01), la enfermedad hepática moderada-grave (OR 5,65; IC 95%=1,11-28,87; p=0,04), el APACHE II (OR 1,14; IC 95%=1,04-1,26; p<0,01) y el SOFA a las 72h (OR 1,19; IC 95%= 1,02-1,40; p=0,03) se relacionan con la mortalidad hospitalaria en el análisis multivariante.

Conclusiones

El retraso en el ingreso en UCI, las comorbilidades y la gravedad del episodio determinan el pronóstico del paciente infectado por VIH ingresado en UCI. Los pacientes con VIH deberían recibir el mismo nivel de cuidados que los pacientes no infectados por VIH, independientemente de su estado inmunológico o nutricional.

Palabras clave:
VIH
TARGA
Pronóstico

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