Medrano José, Álvaro-Meca Alejando, Boyer Alexandre, Jiménez-Sousa María A, Resino Salvador
Crit Care. 2014 Aug 27;18(4):475. doi: 10.1186/s13054-014-0475-3.
The combination antiretroviral therapy (cART) has led to decreased opportunistic infections and hospital admissions in human immunodeficiency virus (HIV)-infected patients, but the intensive care unit (ICU) admission rate remains constant (or even increased in some instances) during the cART era. Hepatitis C virus (HCV) infection is associated with an increased risk for hospital admission and/or mortality (particularly those related to severe liver disease) compared with the general population. The aim of this study was to assess the mortality among HIV-infected patients in ICU, and to evaluate the impact of HIV/HCV coinfection and severe sepsis on ICU mortality.
We carried out a retrospective study based on patients admitted to ICU who were recorded in the Minimum Basic Data Set (2005 through 2010) in Spain. HIV-infected patients (All-HIV-group (n = 1,891)) were divided into two groups: HIV-monoinfected patients (HIV group (n = 1,191)) and HIV/HCV-coinfected patients (HIV/HCV group (n = 700)). A control group (HIV(-)/HCV(-)) was also included (n = 7,496).
All-HIV group had higher frequencies of severe sepsis (57.7% versus 39.4%; P < 0.001) than did the control group. Overall, ICU mortality in patients with severe sepsis was much more frequent than that in patients without severe sepsis (other causes) at days 30 and 90 in HIV-infected patients and the control group (P < 0.001). Moreover, the all-HIV group in the presence or absence of severe sepsis had a higher percentage of death than did the control group at days 7 (P < 0.001), 30 (P < 0.001) and 90 (P < 0.001). Besides, the HIV/HCV group had a higher percentage of death, both in patients with severe sepsis and in patients without severe sepsis compared with the HIV group at days 7 (P < 0.001) and 30 (P < 0.001), whereas no differences were found at day 90. In a bayesian competing-risk model, the HIV/HCV group had a higher mortality risk (adjusted hazard ratio (aHR) = 1.44 (95% CI = 1.30 to 1.59) and aHR = 1.57 (95% CI = 1.38 to 1.78) for patients with and without severe sepsis, respectively).
HIV infection was related to a higher frequency of severe sepsis and death among patients admitted to the ICU. Besides, HIV/HCV coinfection contributed to an increased risk of death in both the presence and the absence of severe sepsis.
联合抗逆转录病毒疗法（cART）已使人类免疫缺陷病毒（HIV）感染患者的机会性感染和住院率降低，但在cART时代，重症监护病房（ICU）的入院率保持不变（在某些情况下甚至有所增加）。与普通人群相比，丙型肝炎病毒（HCV）感染会增加住院和/或死亡风险（尤其是与严重肝病相关的风险）。本研究的目的是评估ICU中HIV感染患者的死亡率，并评估HIV/HCV合并感染和严重脓毒症对ICU死亡率的影响。
我们基于西班牙《最低基本数据集》（2005年至2010年）中记录的入住ICU的患者进行了一项回顾性研究。HIV感染患者（所有HIV组（n = 1,891））分为两组：HIV单一感染患者（HIV组（n = 1,191））和HIV/HCV合并感染患者（HIV/HCV组（n = 700））。还纳入了一个对照组（HIV（-）/HCV（-））（n = 7,496）。
所有HIV组严重脓毒症的发生率（57.7%对39.4%；P < 0.001）高于对照组。总体而言，在HIV感染患者和对照组中，严重脓毒症患者在第30天和第90天的ICU死亡率比无严重脓毒症（其他原因）的患者高得多（P < （此处原文有误，推测应为P < 0.001））。此外，无论有无严重脓毒症，所有HIV组在第7天（P < 0.001）、第30天（P < 0.001）和第90天（P < 0.001）的死亡百分比均高于对照组。此外，在第7天（P < 0.001）和第30天（P < 0.001），与HIV组相比，HIV/HCV组在有严重脓毒症和无严重脓毒症的患者中死亡百分比均更高，而在第90天未发现差异。在贝叶斯竞争风险模型中，HIV/HCV组的死亡风险更高（有严重脓毒症患者的调整风险比（aHR） = 1.44（95%置信区间 = 1.30至1.59），无严重脓毒症患者的aHR = 1.57（95%置信区间 = 1.38至1.78））。
HIV感染与入住ICU患者中严重脓毒症和死亡的发生率较高有关。此外，无论有无严重脓毒症，HIV/HCV合并感染都会增加死亡风险。
