Turvey Shannon L, Bagshaw Sean M, Eurich Dean T, Sligl Wendy I
Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Can J Infect Dis Med Microbiol. 2017;2017:7868954. doi: 10.1155/2017/7868954. Epub 2017 Feb 27.
The impact of critical illness on survival of HIV-infected patients in the era of antiretroviral therapy remains uncertain. We describe the epidemiology of critical illness in this population and identify predictors of mortality. Retrospective cohort of HIV-infected patients was admitted to intensive care from 2002 to 2014. Patient sociodemographics, comorbidities, case-mix, illness severity, and 30-day mortality were captured. Multivariable Cox regression analyses were performed to identify predictors of mortality. Of 282 patients, mean age was 44 years (SD 10) and 169 (59%) were male. Median (IQR) CD4 count and plasma viral load (PVL) were 125 cells/mm (30-300) and 28,000 copies/mL (110-270,000). Fifty-five (20%) patients died within 30 days. Factors independently associated with mortality included APACHE II score (adjusted hazard ratio [aHR] 1.12; 95% CI 1.08-1.16; < 0.001), cirrhosis (aHR 2.30; 95% CI 1.12-4.73; = 0.024), coronary artery disease (aHR 6.98; 95% CI 2.20-22.13; = 0.001), and duration of HIV infection (aHR 1.07 per year; 95% CI 1.02-1.13; = 0.01). CD4 count and PVL were not associated with mortality. Mortality from an episode of critical illness in HIV-infected patients remains high but appears to be driven by acute illness severity and HIV-unrelated comorbid disease rather than degree of immune suppression.
在抗逆转录病毒治疗时代，危重症对HIV感染患者生存的影响仍不确定。我们描述了该人群中危重症的流行病学情况，并确定了死亡预测因素。对2002年至2014年入住重症监护病房的HIV感染患者进行回顾性队列研究。记录患者的社会人口统计学特征、合并症、病例组合、疾病严重程度和30天死亡率。进行多变量Cox回归分析以确定死亡预测因素。282例患者的平均年龄为44岁（标准差10），169例（59%）为男性。CD4细胞计数和血浆病毒载量（PVL）的中位数（四分位间距）分别为125个细胞/mm³（30 - 300）和28,000拷贝/mL（110 - 270,000）。55例（20%）患者在30天内死亡。与死亡率独立相关的因素包括急性生理学与慢性健康状况评分系统II（APACHE II）评分（校正风险比[aHR] 1.12；95%置信区间1.08 - 1.16；P < 0.001）、肝硬化（aHR 2.30；95%置信区间1.12 - 4.73；P = 0.024）、冠状动脉疾病（aHR 6.98；95%置信区间2.20 - 22.13；P = 0.001）以及HIV感染持续时间（每年aHR 1.07；95%置信区间1.02 - 1.13；P = 0.01）。CD4细胞计数和PVL与死亡率无关。HIV感染患者危重症发作的死亡率仍然很高，但似乎是由急性疾病严重程度和与HIV无关的合并症驱动的，而非免疫抑制程度。
