What determines do-not-resuscitate status in critically ill HIV-infected patients admitted to ICU?

Abstract

PurposeTo identify factors associated with do-not-resuscitate (DNR) status in critically ill patients infected with human immunodeficiency virus (HIV) admitted to the Intensive Care Unit (ICU) in the era of combination antiretroviral therapy (cART). Materials and methodsRetrospective cohort study of first-time admissions of HIV-infected patients to ICUs in Edmonton, Alberta, from 2002 to 2014. Multivariable logistic regression analysis was performed to identify factors associated with DNR status. ResultsThere were 282 HIV-infected patients with first-time ICU admissions, with an incidence rate of 6.6 per 1000 ICU admissions. Sixty-seven (24%) patients had a DNR designation and support was withdrawn in 37 (13%). In multivariable analysis, APACHE II score (OR 1.13; 95% CI, 1.08–1.19, p < 0.001), coronary artery disease (OR 5.70; 95% CI, 1.18–27.76, p = 0.031), prior opportunistic infection (OR 2.59; 95% CI, 1.20–5.57, p = 0.015) and duration of HIV infection (OR 1.07 per year; 95% CI, 1.01–1.14, p = 0.025) were independently associated with DNR status. Ethnicity, HIV risk factors, CD4 count and viral load were not associated with DNR status. ConclusionsOne in four patients had a DNR designation. Illness acuity, selected comorbidity, previous opportunistic infection and HIV duration were associated with DNR designation.