Adlakha A, Pavlou M, Walker D A, Copas A J, Dufty N, Batson S, Edwards S G, Singer M, Miller R F
Critical Care Unit, University College London Hospitals, London, UK.
Int J STD AIDS. 2011 Sep;22(9):498-504. doi: 10.1258/ijsa.2011.010496.
We retrospectively studied outcomes for HIV-infected patients admitted to the intensive care unit (ICU) between January 1999 and June 2009. Patient demographics, receipt of highly active antiretroviral therapy (HAART), reason for ICU admission and survival to ICU and hospital discharge were recorded. Comparison was made against outcomes for general medical patients contemporaneously admitted to the same ICU. One hundred and ninety-two HIV-infected patients had 222 ICU admissions; 116 patients required mechanical ventilation (MV) and 43 required renal replacement therapy. ICU admission was due to an HIV-associated diagnosis in 113 patients; 37 had Pneumocystis pneumonia. Survival to ICU discharge and hospital discharge for HIV-infected patients was 78% and 70%, respectively, and was 75% and 68% among 2065 general medical patients with 2274 ICU admissions; P = 0.452 and P = 0.458, respectively. HIV infection was newly diagnosed in 42 patients; their ICU and hospital survival was 69% and 57%, respectively. From multivariable analysis, factors associated with ICU survival were patient's age (odds ratio [OR] = 0.74 [95% confidence interval (CI) = 0.53-1.02] per 10-year increase), albumin (OR = 1.05 [1.00-1.09] per 1 g/dL increase), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 0.55 [0.35-0.87] per 10 unit increase), receipt of HAART (OR = 2.44 [1.01-4.94]) and need for MV (OR = 0.14 [0.06-0.36]). In the era of HAART, HIV-infected patients should be offered ICU admission if it is likely to be of benefit.
我们回顾性研究了1999年1月至2009年6月期间入住重症监护病房（ICU）的HIV感染患者的预后情况。记录了患者的人口统计学资料、接受高效抗逆转录病毒治疗（HAART）的情况、入住ICU的原因以及在ICU存活和出院的情况。与同期入住同一ICU的普通内科患者的预后进行了比较。192例HIV感染患者有222次ICU住院记录；116例患者需要机械通气（MV），43例需要肾脏替代治疗。113例患者因HIV相关诊断入住ICU；37例患有肺孢子菌肺炎。HIV感染患者的ICU出院存活率和医院出院存活率分别为78%和70%，在2065例有2274次ICU住院记录的普通内科患者中，这两个存活率分别为75%和68%；P值分别为0.452和0.458。42例患者新诊断出HIV感染；他们的ICU存活率和医院存活率分别为69%和57%。多变量分析显示，与ICU存活相关的因素包括患者年龄（每增加10岁，比值比[OR]=0.74[95%置信区间（CI）=0.53 - 1.02]）、白蛋白（每增加1 g/dL，OR = 1.05[1.00 - 1.09]）、急性生理与慢性健康状况评估（APACHE）II评分（每增加10分，OR = 0.55[0.35 - 0.87]）、接受HAART治疗（OR = 2.44[1.01 - 4.94]）以及需要MV（OR = 0.14[0.06 - 0.36]）。在HAART时代，如果可能有益，应考虑让HIV感染患者入住ICU。
