Barakat L A, Juthani-Mehta M, Allore H, Trentalange M, Tate J, Rimland D, Pisani M, Akgün K M, Goetz M B, Butt A A, Rodriguez-Barradas M, Duggal M, Crothers K, Justice A C, Quagliarello V J
Infectious Disease, Yale University School of Medicine, New Haven, CT, USA.
Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
HIV Med. 2015 Aug;16(7):421-30. doi: 10.1111/hiv.12244. Epub 2015 May 11.
Outcomes of community-acquired pneumonia (CAP) among HIV-infected older adults are unclear.
Associations between HIV infection and three CAP outcomes (30-day mortality, readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined in the Veterans Aging Cohort Study (VACS) of male Veterans, age ≥ 50 years, hospitalized for CAP from 10/1/2002 through 08/31/2010. Associations between the VACS Index and CAP outcomes were assessed in multivariable models.
Among 117 557 Veterans (36 922 HIV-infected and 80 635 uninfected), 1203 met our eligibility criteria. The 30-day mortality rate was 5.3%, the mean LOS was 7.3 days, and 13.2% were readmitted within 30 days of discharge. In unadjusted analyses, there were no significant differences between HIV-infected and uninfected participants regarding the three CAP outcomes (P > 0.2). A higher VACS Index was associated with increased 30-day mortality, readmission, and LOS in both HIV-infected and uninfected groups. Generic organ system components of the VACS Index were associated with adverse CAP outcomes; HIV-specific components were not. Among HIV-infected participants, those not on antiretroviral therapy (ART) had a higher 30-day mortality (HR 2.94 [95% CI 1.51, 5.72]; P = 0.002) and a longer LOS (slope 2.69 days [95% CI 0.65, 4.73]; P = 0.008), after accounting for VACS Index. Readmission was not associated with ART use (OR 1.12 [95% CI 0.62, 2.00] P = 0.714).
Among HIV-infected and uninfected older adults hospitalized for CAP, organ system components of the VACS Index were associated with adverse CAP outcomes. Among HIV-infected individuals, ART was associated with decreased 30-day mortality and LOS.
HIV 感染的老年社区获得性肺炎（CAP）患者的预后尚不清楚。
在退伍军人老龄化队列研究（VACS）中，对年龄≥50岁、于2002年10月1日至2010年8月31日因CAP住院的男性退伍军人，研究HIV感染与三种CAP预后（30天死亡率、出院后30天内再入院率和住院时间[LOS]）之间的关联。在多变量模型中评估VACS指数与CAP预后之间的关联。
在117557名退伍军人（36922名HIV感染者和80635名未感染者）中，1203人符合我们的纳入标准。30天死亡率为5.3%，平均住院时间为7.3天，13.2%的患者在出院后30天内再次入院。在未调整的分析中，HIV感染者和未感染者在三种CAP预后方面无显著差异（P>0.2）。较高的VACS指数与HIV感染者和未感染者的30天死亡率、再入院率和住院时间增加相关。VACS指数的一般器官系统组成部分与不良CAP预后相关；HIV特异性组成部分则不然。在HIV感染者中，未接受抗逆转录病毒治疗（ART）的患者30天死亡率较高（HR 2.94[95%CI 1.51,5.72]；P = 0.002）且住院时间较长（斜率2.69天[95%CI 0.65,4.73]；P = 0.008），在考虑VACS指数后。再入院与ART使用无关（OR 1.12[95%CI 0.62,2.00]P = 0.714）。
在因CAP住院的HIV感染和未感染的老年人中，VACS指数的器官系统组成部分与不良CAP预后相关。在HIV感染者中，ART与降低30天死亡率和住院时间相关。
