Short- and medium-term prognosis of HIV-infected patients receiving intensive care: a Brazilian multicentre prospective cohort study.

Autor: Andrade HB; Intensive Care Unit of the Evandro Chagas National Institute of Infectology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.; Sexually Transmitted Diseases Sector, Biomedical Institute, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil., da Silva I; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA., Ramos GV; Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil., Medeiros DM; Intensive Care Unit of the Evandro Chagas National Institute of Infectology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil., Ho YL; Infectious Diseases Intensive Care Unit of Hospital das Clínicas, Medical School of the University of São Paulo, São Paulo, SP, Brazil., de Carvalho FB; Intensive Care Unit of Hospital Eduardo de Menezes, Hospital Foundation of the State of Minas Gerais, Belo Horizonte, MG, Brazil., Bozza FA; Intensive Care Unit of the Evandro Chagas National Institute of Infectology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.; Department of Critical Care, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil., Japiassú AM; Intensive Care Unit of the Evandro Chagas National Institute of Infectology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.
Jazyk: angličtina
Zdroj: HIV medicine [HIV Med] 2020 Nov; Vol. 21 (10), pp. 650-658. Date of Electronic Publication: 2020 Sep 02.
DOI: 10.1111/hiv.12939
Abstrakt: Objectives: The characteristics of critically ill HIV-positive patients and the causes of their admission to intensive care units (ICUs) are only known through retrospective and unicentric studies. This study aims to fill this knowledge gap.
Methods: This is a prospective, multicentre cohort study of short- and medium-term prognostic factors. The setting consisted of ICUs of three tertiary referral hospitals from the three largest metropolitan areas in Brazil in the period January 2014 to November 2015. In all, 161 HIV patients over 18 years old were included.
Results: The clinical data of the outcomes (ICU mortality, hospital mortality and 90-day survival) were extracted from medical records using the REDCap ®️ web-based form and analysed with the MedCalc ® ️ application. Median age was 41.7 [interquartile range (IQR): 34-50] years, the Simplified Acute Physiologic Score 3 (SAPS 3) was 64 (IQR: 56-74), and the Sequential Organ Failure Assessment Score (SOFA) was 6 (IQR: 4-9) points. The main causes of admission were sepsis (54.5%) and acute respiratory failure (13.7%). ICU and hospital mortality rates were 32.3% and 40.4%, respectively. In a multivariate analysis, time until ICU admission ≥ 3 days (P = 0.0013), performance status (Eastern Cooperative Oncology Group score, P = 0.0344), coma (Glasgow Coma Scale ≤ 8 points, P = 0.0213) and sepsis (P = 0.0003) were associated with increased hospital mortality. Coma (P = 0.0002) and sepsis (P = 0.0008) were independently associated with 90-day survival.
Conclusions: Delayed ICU admission and the severity of critical illness determine the short- and medium-term mortality rates of HIV-infected patients admitted to the ICU, rather than factors associated with HIV infection. These results suggest that prognostic factors of HIV-infected patients in the ICU are similar to those of non-HIV-infected populations.
(© 2020 British HIV Association.)
Databáze: MEDLINE
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