Wen Ying, Zhou Ying, Wang Wen, Wang Yu, Lu Xu, Sun Cui Ming, Cui Wei, Liu Jing, Geng Wen Qing, Shang Hong, Liu Pei
Department of Infectious Diseases, The First Affiliated Hospital, China Medical University, China.
Intern Med. 2014;53(21):2455-61. doi: 10.2169/internalmedicine.53.2502. Epub 2014 Nov 1.
Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper, we herein describe clinical characteristics, laboratory findings, causes of clinical deterioration, and risk factors associated with mortality among HIV-1 patients within six months after hospital admission.
We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality.
A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis, tuberculosis, cytomegaloviremia, and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts, hypoalbuminemia, anemia, hyponatremia, as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ T-cell counts as well as low creatinine, hemoglobin, albumin, and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI), 1.006-7.142; p=0.049], hyponatremia (OR: 3.027; 95% CI, 1.238-7.401; p=0.015), and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI, 1.200-75.065; p=0.033) within the first six months of admission.
Special consideration should be given to patients who have active tuberculosis, are at clinical stage 4, and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.
尽管重症人类免疫缺陷病毒1型（HIV-1）患者的长期死亡率有所下降，但短期死亡率仍然很高。在中国，短期死亡率的基线风险因素尚未确定。在本文中，我们描述了HIV-1患者入院后6个月内的临床特征、实验室检查结果、临床病情恶化原因以及与死亡率相关的风险因素。
我们对晚期HIV感染的住院患者进行了一项前瞻性研究。这些患者在入院后三到四周开始接受抗逆转录病毒治疗。随访期为6个月。我们使用多因素逻辑回归分析来确定与死亡率相关的风险因素。
共有141名患者符合我们的纳入标准。平均年龄为41岁。发热和体重减轻是晚期HIV疾病最常见的临床表现。口腔念珠菌病、结核病、巨细胞病毒血症和肺孢子菌肺炎是最常见的机会性感染。CD4+T细胞计数显著降低、低白蛋白血症、贫血、低钠血症以及C反应蛋白（CRP）和谷丙转氨酶水平升高是常见的实验室检查异常。死亡率为21.3%。死亡患者比存活患者更有可能CD4+T细胞计数低，同时肌酐、血红蛋白、白蛋白和血清钠水平也低，此外发热时间更长且CRP水平更高。多因素分析表明，死亡率的独立风险因素是活动性结核病[比值比（OR）：2.681；95%置信区间（CI），1.006 - 7.142；P = 0.049]、低钠血症（OR：3.027；95%CI，1.238 - 7.401；P = 0.015）以及入院后前6个月处于世界卫生组织定义的临床4期（OR：9.492；95%CI，1.200 - 75.065；P = 0.033）。
对于入院时患有活动性结核病、处于临床4期且伴有低钠血症的患者应给予特别关注，因为这些因素被发现是HIV-1患者入院后6个月内与死亡率相关的重要因素。
