Epidemiology and outcome of HIV-infected patients admitted to the ICU in the current highly active antiretroviral therapy era

Abstract

PurposeTo 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. MethodsA 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. ResultsA 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. ConclusionsDelayed 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.