Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza 404-D, Houston, TX 77030, USA.
Surg Infect (Larchmt). 2010 Feb;11(1):41-7. doi: 10.1089/sur.2008.050.
The prevalence of human immunodeficiency virus (HIV) is disproportionately elevated in trauma patients. Although HIV traditionally has been associated with poorer outcomes among the critically ill, recent evidence suggests that the outcomes of surgical patients have improved with the greater use of antiretroviral regimens. The purpose of this study was to utilize the National Trauma Data Bank (NTDB) to examine the impact of HIV on surgical outcomes in a large group of trauma patients.
We identified all patients for whom HIV status at time of admission was recorded. Results were stratified by age and Injury Severity Score. Our primary outcome was death. Secondary outcomes were length of hospital stay (LOS), length of intensive care unit (ICU) stay, duration of mechanical ventilation, and complications. Data were analyzed using Student t-tests or chi-square analysis, as appropriate.
The overall mortality rates were not significantly different in the HIV-positive and HIV-negative groups. Mortality rates remained similar in the two groups even when stratifying by ISS and age, with the exception of those patients who were 65 years or older. The HIV-positive patients had significantly longer LOS (7.6 vs. 5.6 days), shorter duration of mechanical ventilation (6.3 vs. 8.3 days), and no difference in length of ICU stay. The HIV-positive patients were significantly more likely to develop pneumonia, bacteremia, or wound infection.
These findings are consistent with those of recent smaller studies that demonstrated no significant difference in the mortality rate for patients with HIV. Although mortality rates are similar, HIV-positive patients are more likely to develop certain infectious complications and to require a longer LOS. Infection with HIV remains a major public health issue in the U.S. and internationally, and further research is necessary to explore the relation between HIV status and trauma outcomes, particularly with regard to the possible effects of antiretroviral treatment and individual immune status.
人类免疫缺陷病毒（HIV）在创伤患者中的流行率不成比例地升高。尽管 HIV 传统上与危重症患者的预后较差有关，但最近的证据表明，随着抗逆转录病毒方案的广泛应用，手术患者的预后有所改善。本研究旨在利用国家创伤数据库（NTDB）检查 HIV 对大量创伤患者手术结果的影响。
我们确定了所有入院时记录 HIV 状态的患者。结果按年龄和损伤严重程度评分分层。我们的主要结果是死亡。次要结果是住院时间（LOS）、重症监护病房（ICU）停留时间、机械通气时间和并发症。使用学生 t 检验或卡方分析（视情况而定）分析数据。
HIV 阳性和 HIV 阴性组的总体死亡率无显著差异。即使按 ISS 和年龄分层，两组的死亡率仍然相似，只有 65 岁或以上的患者除外。HIV 阳性患者的 LOS（7.6 天 vs. 5.6 天）明显更长，机械通气时间（6.3 天 vs. 8.3 天）更短，ICU 停留时间无差异。HIV 阳性患者发生肺炎、菌血症或伤口感染的可能性显著更高。
这些发现与最近的一些小型研究一致，这些研究表明 HIV 患者的死亡率没有显著差异。尽管死亡率相似，但 HIV 阳性患者更有可能发生某些感染性并发症，需要更长的 LOS。HIV 感染仍然是美国和国际上的一个主要公共卫生问题，需要进一步研究来探讨 HIV 状态与创伤结果之间的关系，特别是抗逆转录病毒治疗和个体免疫状态的可能影响。
