Abstract
IntroductionAlthough access to highly active antiretroviral therapy (HAART) has prolonged survival and improved life quality, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support in intensive care units (ICU). This study aimed to describe the etiology and analyze the prognostic factors of HIV-infected Taiwanese patients in the HAART era.MethodsMedical records of all HIV-infected adults who were admitted to ICU at a university hospital in Taiwan from 2001 to 2010 were reviewed to record information on patient demographics, receipt of HAART, and reason for ICU admission. Factors associated with hospital mortality were analyzed.ResultsDuring the 10-year study period, there were 145 ICU admissions for 135 patients, with respiratory failure being the most common cause (44.4%), followed by sepsis (33.3%) and neurological disease (11.9%). Receipt of HAART was not associated with survival. However, CD4 count was independently predictive of hospital mortality (adjusted odds ratio [AOR], per-10 cells/mm3 decrease, 1.036; 95% confidence interval [CI], 1.003 to 1.069). Admission diagnosis of sepsis was independently associated with hospital mortality (AOR, 2.91; 95% CI, 1.11 to 7.62). A hospital-to-ICU interval of more than 24 hours and serum albumin level (per 1-g/dl decrease) were associated with increased hospital mortality, but did not reach statistical significance in multivariable analysis.ConclusionsRespiratory failure was the leading cause of ICU admissions among HIV-infected patients in Taiwan. Outcome during the ICU stay was associated with CD4 count and the diagnosis of sepsis, but was not associated with HAART in this study.
Highlights
Access to highly active antiretroviral therapy (HAART) has prolonged survival and improved life quality, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support in intensive care units (ICU)
We aimed to describe the etiologies of ICU admissions of HIV-infected patients in a university hospital in Taiwan and to examine the prognostic factors of hospital mortality in the era of HAART
8.1% of the patients admitted to ICU had diagnoses of P. jirovecii pneumonia, and 25.9% of the patients were classified as interstitial pneumonitis with unknown etiology, which might be probable cases of P. jirovecii pneumonia when the radiographic findings and clinical response to specific anti-pneumocystosis therapy were taken into consideration
Summary
Access to highly active antiretroviral therapy (HAART) has prolonged survival and improved life quality, HIV-infected patients with severe immunosuppression or comorbidities may develop complications that require critical care support in intensive care units (ICU). In the era of HAART, prognostic factors of mortality for HIV-infected patients admitted to ICU do not appear to have significant changes [8,12,14,15,16,17,18,19,20] These factors include the severity of acute illness (as assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Simplified Acute Physiology Score II (SAPS II), or Sequential Organ Failure Assessment (SOFA) score), presence of organ failure (requirement of mechanical ventilator support, shock, renal failure), CD4 lymphocyte count, hospital-to-ICU interval, and serum albumin level. It remains unknown whether HIV-infected patients in the Asia-Pacific countries who are admitted to the ICU share the same etiologies and prognostic factors
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