Ji Yongjia, Wang Zhenyan, Shen Jiayin, Chen Jun, Yang Junyang, Qi Tangkai, Song Wei, Tang Yang, Liu Li, Shen Yinzhong, Zhang Renfang, Lu Hongzhou
Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University.
Biosci Trends. 2017 Mar 22;11(1):62-68. doi: 10.5582/bst.2016.01195. Epub 2017 Jan 30.
Globally, the overall mortality rate among HIV-infected patients has significantly declined during the HAART era. Deaths among HIV-infected inpatients need to be characterized in order to formulate intervention strategies to further improve medical care for this population and their prognosis. In the current study, deaths among HIV-infected inpatients from 2006 to 2015 at a medical center for HIV infection and AIDS patient care in Shanghai, China were retrospectively analyzed. Trends in mortality rates and the proportion of deaths caused by AIDS or non-AIDS-related illnesses were evaluated. A bivariate analysis was performed to identify the demographic and clinical factors associated with AIDS or non-AIDS-related deaths among HIV-infected inpatients. Among 6,473 HIV-infected patients who were discharged from 2006 to 2015, 326 deaths (5.04%) were identified. The yearly mortality rate declined significantly over time (χ = 34.41, p < 0.001). Results revealed that most deaths were attributed to AIDS-related illnesses (76.9 %, 233/303), and the proportion of causes of death did not change significantly over time (χ = 13.847, p = 0.127). Bivariate analysis identified characteristic factors associated with AIDS-related mortality. Compared to patients who died of non-AIDS illnesses, patients who died of AIDS-related illnesses had a CD4+ T cell count lower than 50 cells/μL (OR 4.587, 2.377-8.850) and fewer liver (OR 0.391, 0.177-0.866) or renal comorbidities (OR 0.188, 0.067-0.523) on admission. Results indicated that the overall in-hospital mortality rate among HIV-infected patients has declined over the past decade. However, AIDS-related illnesses were still the major causes of deaths among HIV-infected inpatients, suggesting that further efforts are needed to improve AIDS care in China.
在全球范围内，在高效抗逆转录病毒治疗（HAART）时代，HIV感染患者的总体死亡率显著下降。为了制定干预策略以进一步改善对这一人群的医疗护理及其预后，需要对HIV感染住院患者的死亡情况进行特征描述。在本研究中，对2006年至2015年期间中国上海一家HIV感染与艾滋病患者护理医疗中心的HIV感染住院患者的死亡情况进行了回顾性分析。评估了死亡率趋势以及由艾滋病或非艾滋病相关疾病导致的死亡比例。进行了双变量分析以确定与HIV感染住院患者中艾滋病或非艾滋病相关死亡相关的人口统计学和临床因素。在2006年至2015年出院的6473例HIV感染患者中，确定了326例死亡（5.04%）。年死亡率随时间显著下降（χ = 34.41，p < 0.001）。结果显示，大多数死亡归因于艾滋病相关疾病（76.9%，233/303），且死亡原因比例随时间没有显著变化（χ = 13.847，p = 0.127）。双变量分析确定了与艾滋病相关死亡率相关的特征因素。与死于非艾滋病疾病的患者相比，死于艾滋病相关疾病的患者入院时CD4 + T细胞计数低于50个细胞/μL（比值比4.587，2.377 - 8.850），且肝脏（比值比0.391，0.177 - 0.866）或肾脏合并症较少（比值比0.188，0.067 - 0.523）。结果表明，在过去十年中，HIV感染患者的总体住院死亡率有所下降。然而，艾滋病相关疾病仍然是HIV感染住院患者的主要死亡原因，这表明中国需要进一步努力改善艾滋病护理。
