Mkoko P, Raine R I
Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2017 Sep 22;107(10):877-881. doi: 10.7196/SAMJ.2017.v107i10.12298.
The indications for and outcomes of intensive care unit (ICU) admission of HIV-positive patients in resource-poor settings such as sub-Saharan Africa are unknown.
To identify indications for ICU admission and determine factors associated with high ICU and hospital mortality in HIV-positive patients.
We reviewed case records of HIV-positive patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, Cape Town, South Africa, from 1 January 2012 to 31 December 2012.
Seventy-seven HIV-positive patients were admitted to an ICU, of whom two were aged <18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during the study period. HIV-positive patients had a median CD4 count of 232.5 (interquartile range 59 - 459) cells/µL. Respiratory illness, mainly community-acquired pneumonia, accounted for 30.7% of ICU admissions. ICU and hospital mortality rates were 25.3% and 34.7%, respectively. Predictors of ICU mortality included an Acute Physiology and Chronic Health Evaluation ΙΙ (APACHE II) score >13 (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.1 - 1.7; p=0.015), receipt of renal replacement therapy (RRT) (OR 2.2, 95% CI 1.2 - 4.1; p=0.018) and receipt of inotropes (OR 2.3, 95% CI 1.6 - 3.4; p<0.001). Predictors of hospital mortality were severe sepsis on admission (OR 2.8, 95% CI 0.9 - 9.1; p=0.07), receipt of RRT (OR 1.9, 95% CI 1.0 - 3.6; p=0.056) and receipt of inotropic support (OR 2.0, 95% CI 1.4 - 3.2; p<0.001). Use of highly active antiretroviral therapy (HAART), CD4 count, detectable HIV viral load and diagnosis at ICU admission did not predict ICU or hospital mortality.
Respiratory illnesses remain the main indication for ICU in HIV-positive patients. HIV infection is often diagnosed late, with patients presenting with life-threatening illnesses. Severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and RRT, rather than receipt of HAART, CD4 count and diagnosis at ICU admission, are predictors of ICU and hospital mortality.
在撒哈拉以南非洲等资源匮乏地区，HIV阳性患者入住重症监护病房（ICU）的指征及预后尚不清楚。
确定HIV阳性患者入住ICU的指征，并确定与ICU及医院高死亡率相关的因素。
我们回顾了2012年1月1日至2012年12月31日期间入住南非开普敦格罗特舒尔医院内科及外科ICU的HIV阳性患者的病例记录。
77例HIV阳性患者入住ICU，其中2例年龄小于18岁，被排除在最终分析之外。在研究期间入院的患者中，37.3%为新诊断的HIV感染。HIV阳性患者的CD4细胞计数中位数为232.5（四分位间距59 - 459）个/µL。呼吸系统疾病，主要是社区获得性肺炎，占ICU入院病例的30.7%。ICU死亡率和医院死亡率分别为25.3%和34.7%。ICU死亡率的预测因素包括急性生理与慢性健康状况评分系统Ⅱ（APACHE II）评分>13（比值比（OR）1.4，95%置信区间（CI）1.1 - 1.7；p = 0.015）、接受肾脏替代治疗（RRT）（OR 2.2，95% CI 1.2 - 4.1；p = 0.018）和接受血管活性药物治疗（OR 2.3，95% CI 1.6 - 3.4；p<0.001）。医院死亡率的预测因素为入院时严重脓毒症（OR 2.8，95% CI 0.9 - 9.1；p = 0.07）、接受RRT（OR 1.9，95% CI 1.0 - 3.6；p = 0.056）和接受血管活性药物支持（OR 2.0，95% CI 1.4 - 3.2；p<0.001）。使用高效抗逆转录病毒治疗（HAART）、CD4细胞计数、可检测到的HIV病毒载量以及ICU入院时的诊断并不能预测ICU或医院死亡率。
呼吸系统疾病仍然是HIV阳性患者入住ICU的主要指征。HIV感染常常诊断较晚，患者表现为危及生命的疾病。高APACHE II评分所表明的疾病严重程度、需要血管活性药物支持和RRT的多器官功能障碍，而非接受HAART、CD4细胞计数和ICU入院时的诊断，是ICU及医院死亡率的预测因素。
