Ferreira Marcia Danielle, Neves Cynthia Pessoa das, Souza Alexandra Brito de, Beraldi-Magalhães Francisco, Migliori Giovanni Battista, Kritski Afrânio Lineu, Cordeiro-Santos Marcelo
Universidade do Estado do Amazonas, Manaus, AM, Brazil.
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil.
J Bras Pneumol. 2018 Apr;44(2):118-124. doi: 10.1590/s1806-37562017000000316.
To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region.
This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model.
During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002).
A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.
确定亚马逊地区玛瑙斯市入住重症监护病房（ICU）的结核病（TB）/人类免疫缺陷病毒（HIV）合并感染患者的死亡预测因素。
这是一项回顾性队列研究，研究对象为2011年1月至2014年12月期间入住巴西玛瑙斯市一家ICU的18岁以上TB/HIV合并感染患者。评估了社会人口统计学、临床和实验室变量。为了确定死亡预测因素，我们采用了Cox比例风险模型。
在研究期间，120例TB/HIV合并感染患者入住ICU。平均年龄为37.0±11.7岁。在评估的120例患者中，94例（78.3%）死亡，其中62例（66.0%）在入院后第一周内死亡。分别有86例和67例患者有有创机械通气（IMV）和急性呼吸窘迫综合征（ARDS）的数据。在这86例患者中，75例（87.2%）接受了IMV，在这67例患者中，48例（71.6%）出现ARDS。发现与死亡率独立相关的因素为IMV（p = 0.002）、低白蛋白血症（p = 0.013）和CD4细胞计数<200个/立方毫米（p = 0.002）。
TB/HIV合并感染的ICU患者早期死亡率较高。该人群的死亡预测因素为IMV、低白蛋白血症和严重免疫抑制。
