Intensive Care Unit, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365, Rio de Janeiro, Brazil.
Crit Care. 2010;14(4):R152. doi: 10.1186/cc9221. Epub 2010 Aug 10.
New challenges have arisen for the management of critically ill HIV/AIDS patients. Severe sepsis has emerged as a common cause of intensive care unit (ICU) admission for those living with HIV/AIDS. Contrastingly, HIV/AIDS patients have been systematically excluded from sepsis studies, limiting the understanding of the impact of sepsis in this population. We prospectively followed up critically ill HIV/AIDS patients to evaluate the main risk factors for hospital mortality and the impact of severe sepsis on the short- and long-term survival.
All consecutive HIV-infected patients admitted to the ICU of an infectious diseases research center, from June 2006 to May 2008, were included. Severity of illness, time since AIDS diagnosis, CD4 cell count, antiretroviral treatment, incidence of severe sepsis, and organ dysfunctions were registered. The 28-day, hospital, and 6-month outcomes were obtained for all patients. Cox proportional hazards regression analysis measured the effect of potential factors on 28-day and 6-month mortality.
During the 2-year study period, 88 HIV/AIDS critically ill patients were admitted to the ICU. Seventy percent of patients had opportunist infections, median CD4 count was 75 cells/mm3, and 45% were receiving antiretroviral therapy. Location on a ward before ICU admission, cardiovascular and respiratory dysfunctions on the first day after admission, and the presence of severe sepsis/septic shock were associated with reduced 28-day and 6-month survival on a univariate analysis. After a multivariate analysis, severe sepsis determined the highest hazard ratio (HR) for 28-day (adjusted HR, 3.13; 95% CI, 1.21-8.07) and 6-month (adjusted HR, 3.35; 95% CI, 1.42-7.86) mortality. Severe sepsis occurred in 44 (50%) patients, mainly because of lower respiratory tract infections. The survival of septic and nonseptic patients was significantly different at 28-day and 6-month follow-up times (log-rank and Peto test, P < 0.001).
Severe sepsis has emerged as a major cause of admission and mortality for hospitalized HIV/AIDS patients, significantly affecting short- and longer-term survival of critically ill HIV/AIDS patients.
新的挑战已经出现在对重症 HIV/AIDS 患者的管理中。严重脓毒症已成为 HIV/AIDS 患者入住重症监护病房（ICU）的常见原因。相反，HIV/AIDS 患者被系统地排除在脓毒症研究之外，限制了对该人群中脓毒症影响的理解。我们前瞻性地随访了重症 HIV/AIDS 患者，以评估医院死亡率的主要危险因素以及严重脓毒症对短期和长期生存的影响。
纳入 2006 年 6 月至 2008 年 5 月期间入住传染病研究中心 ICU 的所有连续 HIV 感染患者。记录疾病严重程度、艾滋病诊断后时间、CD4 细胞计数、抗逆转录病毒治疗、严重脓毒症的发生以及器官功能障碍。所有患者均获得 28 天、住院和 6 个月的结局。Cox 比例风险回归分析测量了潜在因素对 28 天和 6 个月死亡率的影响。
在 2 年的研究期间，共收治 88 例 HIV/AIDS 重症患者。70%的患者有机会性感染，中位 CD4 计数为 75 个细胞/mm3，45%的患者正在接受抗逆转录病毒治疗。入住 ICU 前在病房的位置、入住后第一天的心血管和呼吸系统功能障碍以及严重脓毒症/脓毒性休克的存在，与 28 天和 6 个月生存的单因素分析相关。经过多因素分析，严重脓毒症确定了 28 天（调整后的 HR，3.13；95%CI，1.21-8.07）和 6 个月（调整后的 HR，3.35；95%CI，1.42-7.86）死亡率的最高危险比（HR）。44 例（50%）患者发生严重脓毒症，主要是由于下呼吸道感染。在 28 天和 6 个月的随访时间上，脓毒症和非脓毒症患者的生存情况差异显著（对数秩和 Peto 检验，P < 0.001）。
严重脓毒症已成为住院 HIV/AIDS 患者入院和死亡的主要原因，严重影响了重症 HIV/AIDS 患者的短期和长期生存。
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