1Pulmonary Medicine, Department of Veterans Affairs, Atlanta, GA. 2Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, GA. 3Department of Medicine, Legacy Meridian Park Medical Center, Tualatin, OR. 4Emory University, Atlanta, GA. 5Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA.
Crit Care Med. 2015 Aug;43(8):1638-45. doi: 10.1097/CCM.0000000000001003.
Although highly active antiretroviral therapy has led to improved survival in HIV-infected individuals, outcomes for HIV-infected patients with sepsis in the post-highly active antiretroviral therapy era are conflicting. Access to highly active antiretroviral therapy and healthcare disparities continue to affect outcomes. We hypothesized that HIV-infected patients with severe sepsis would have worse outcomes compared with their HIV-uninfected counterparts in a large safety-net hospital where access to healthcare is low and delivery of critical care is delayed.
Secondary analysis of an ongoing prospective observational study between 2006 and 2010.
Three adult ICUs (medical ICU, surgical ICU, and neurologic ICU) at Grady Memorial Hospital, Atlanta, GA.
Adult patients with severe sepsis in the ICU.
Baseline patient characteristics and clinical outcomes were collected. HIV-infected and HIV-uninfected patients with sepsis were compared using t tests, chi-square tests, and logistic regression; p values less than 0.05 indicated significance.
Of 1,095 patients with severe sepsis enrolled, 165 (15%) were positive for HIV, with a median CD4 count of 41 (8-167). Twenty-two percent of HIV-infected patients were on highly active antiretroviral therapy prior to admission, and 80% had a CD4 count less than 200. HIV-infected patients had a greater hospital mortality (50% vs 38%; p < 0.01). HIV infection (odds ratio = 1.78; p = 0.005) was an independent predictor of mortality by multivariate regression modeling after adjusting for age, history of pneumonia, history of hospital-acquired infection, and history of sepsis.
HIV-infected patients with severe sepsis continue to suffer worse outcomes compared with HIV-uninfected patients in a large urban safety-net hospital caring for patients with limited access to medical care. Further studies need to be done to investigate the effect of socioeconomic status and mitigate healthcare disparities among critically ill HIV-infected patients.
尽管高效抗逆转录病毒疗法（highly active antiretroviral therapy，HAART）的应用提高了 HIV 感染者的生存率，但在 HAART 时代后，HIV 感染者合并脓毒症的结局仍存在争议。获得 HAART 和医疗保健方面的差异继续影响着结局。我们假设，在一个获得医疗保健的机会较少、提供重症监护服务延迟的大型医疗保障医院中，与 HIV 未感染者相比，HIV 感染者合并严重脓毒症的患者结局更差。
一项正在进行的前瞻性观察性研究的二次分析，时间为 2006 年至 2010 年。
亚特兰大 Grady 纪念医院的 3 个成人重症监护病房（内科 ICU、外科 ICU 和神经科 ICU）。
重症监护病房中合并严重脓毒症的成年患者。
收集患者的基线特征和临床结局。采用 t 检验、卡方检验和 logistic 回归比较 HIV 感染者和 HIV 未感染者的脓毒症患者；p 值小于 0.05 表示有统计学意义。
共纳入 1095 例严重脓毒症患者，165 例（15%） HIV 检测阳性，CD4 计数中位数为 41（8-167）。22%的 HIV 感染者在入院前正在接受高效抗逆转录病毒治疗，80%的患者 CD4 计数小于 200。HIV 感染者的院内死亡率更高（50% vs 38%；p < 0.01）。多变量回归模型校正年龄、肺炎史、医院获得性感染史和脓毒症史后，HIV 感染（比值比 = 1.78；p = 0.005）是死亡的独立预测因素。
在一家为获得医疗保健机会有限的患者服务的大型城市医疗保障医院中，与 HIV 未感染者相比，HIV 感染者合并严重脓毒症的患者结局仍更差。需要进一步研究来调查社会经济地位的影响，并减轻重症 HIV 感染者的医疗保健差异。
