Abstract
BackgroundPredictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh.ObjectiveThe primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh.MethodsA study was conducted in the HIV in-patient unit (Jagori Ward) of icddr,b's Dhaka Hospital. Characteristics of patients who died during hospitalization were compared to those of patients discharged from the ward. Bivariate analysis was performed to determine associations between potential risk factors and death. Multivariable logistic regression was used to identify factors independently associated with death.ResultsOf 293 patients admitted to the Jagori Ward, 57 died during hospitalization. Most hospitalized patients (67%) were male and the median age was 35 (interquartile range: 2–65) years. Overall, 153 (52%) patients were diagnosed with HIV within 6 months of hospitalization. The most common presumptive opportunistic infections (OIs) identified were tuberculosis (32%), oesophageal candidiasis (9%), Pneumocystis jirovecii pneumonia (PJP) (8%), and histoplasmosis (7%). On multivariable analysis, independent predictors of mortality were CD4 count ≤200 cells/mm3 (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 3.7–74.4), PJP (aOR: 18.5, 95% CI: 4.68–73.3), oesophageal candidiasis (aOR: 27.5, 95% CI: 5.5–136.9), malignancy (aOR:15.2, 95% CI: 2.3–99.4), and bacteriuria (aOR:7.9, 95% CI: 1.2–50.5). Being on antiretroviral therapy prior to hospitalization (aOR: 0.2, 95% CI: 0.06–0.5) was associated with decreased mortality.ConclusionThis study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of OIs. It is prudent to develop a national HIV screening programme to facilitate early identification of HIV.
Highlights
Predictors of death in hospitalized human immunodeficiency virus (HIV)-infected patients have not been previously reported in Bangladesh
Predictors of Death in HIV in Bangladesh were CD4 count #200 cells/mm3, Pneumocystis jirovecii pneumonia (PJP), oesophageal candidiasis, malignancy, and bacteriuria
This study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of opportunistic infections (OIs)
Summary
Predictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh. Objective: The primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh. The experience from the Jagori Ward’s first 21 months (from May 2008 to February 2010) has been previously reported; we found that 38% of those who died had active tuberculosis (TB) and that the majority of patients admitted to the ward had a CD4 cell count ,50 cells/mm3 [9]. A secondary objective was to estimate the proportion of deaths among those hospitalized on the Jagori Ward Such data could provide critical information about severity of HIV in PLHIV and lead to improvement of the clinical management of PLHIV in this low-prevalence country
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