Community-Acquired Bacterial Pneumonia in Human Immunodeficiency Virus–Infected Patients
| Autor: | Elisa Cordero, Jesús Gómez-Mateos, Antonio Collado, José A. Girón, Jerónimo Pachón, José Hernández-Quero, Enrique Nuño, Antonio Rivero, Manuel Torres-Tortosa, Luis Aliaga, María D. Merino, Mercedes González-Serrano, Antonio Barrera |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty education.field_of_study Pleural effusion business.industry Respiratory disease Population Bacterial pneumonia Critical Care and Intensive Care Medicine medicine.disease Surgery Pneumonia Internal medicine Severity of illness medicine education Prospective cohort study business Cohort study |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine. 162:2063-2068 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/ajrccm.162.6.9910104 |
| Popis: | Severity criteria for community-acquired pneumonia (CAP) have always excluded patients with human immunodeficiency virus (HIV) infection. A 1-yr, multicenter, prospective observational study of HIV-infected patients with bacterial CAP was done to validate the criteria used in the American Thoracic Society (ATS) guidelines for CAP, and to determine the prognosis-associated factors in the HIV-infected population with bacterial CAP. Overall, 355 cases were included, with an attributable mortality of 9.3%. Patients who met the ATS criteria had a longer hospital stay (p = 0.01), longer duration of fever (p < 0.001), and higher attributable mortality (13.1% versus 3.5%, p = 0.02) than those who did not. Three factors were independently related to mortality: CD4(+) cell count < 100/microl, radiologic progression of disease, and shock. Pleural effusion, cavities, and/or multilobar infiltrates at admission were independently associated with radiologic progression. A prognostic rule based on the five criteria of shock, CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar infiltrates had a high negative predictive value for mortality (97.1%). The attributable mortality for severe pneumonia was 11.3%, as compared with 1.3% for nonsevere disease (p = 0.008). The ATS severity criteria are valid in HIV-infected patients with bacterial CAP. Our study provides the basis for identification of patients who may require hospitalization determined by clinical judgment and the five clinical criteria of shock, a CD4(+) cell count < 100/microl, pleural effusion, cavities, and multilobar involvement. These prognostic factors should be validated in independent cohort studies. |
| Databáze: | OpenAIRE |
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