HIV 状态对急性哮喘加重的管理的影响。
Influence of HIV status on the management of acute asthma exacerbations.
机构信息
Clinical Assistant Professor, Medicine, BronxCare Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, NY, USA, Bronx, New York, USA.
Medicine, BronxCare Hospital Center, Bronx, New York, USA.
出版信息
BMJ Open Respir Res. 2019 Dec 23;6(1):e000472. doi: 10.1136/bmjresp-2019-000472. eCollection 2019.
BACKGROUND
An increased incidence of asthma has been suggested in patients with HIV. We aimed to compare the outcomes of HIV-positive and HIV-negative patients following hospital admission for asthma exacerbation.
METHODS
A retrospective chart review of patients hospitalised between January 2015 and December 2017 owing to asthma exacerbation with a known HIV status was conducted.
RESULTS
During the study period, 1242 patients with asthma were admitted. Of these, 462 patients had a known HIV status (358 HIV-negative, 104 HIV-positive) and were included. No differences in baseline demographics, including age, sex, body mass index and underlying comorbid conditions, were identified between the groups except that HIV-negative patients had higher incidence of underlying congestive heart failure. HIV-positive group had a significantly higher serum creatinine levels (1.117 (1.390) vs 0.813 (0.509), p=0.001), higher serum eosinophil levels (492.91 (1789.09) vs 243.70 (338.66), p=0.013) but had lower serum neutrophils (5.74 (3.18) vs 7.194 (3.59), p=0.0002) and lower serum albumin levels (3.754 (0.480) vs 3.94 (0.443), p=0.003) than the HIV-negative group, respectively. Non-invasive positive pressure ventilation (NIPPV) use was more frequent (54.8% vs 25.4%, p≤0.001) and the length of in-hospital stay (LOS) was longer in HIV-positive vs HIV-negative patients (3.346 days vs 2.813 days, p=0.015); no differences in mechanical ventilation use or intensive care unit admission were noted between the groups. In a subgroup analysis comparing HIV-negative with HIV-positive patients stratified by CD4 count, NIPPV use was more frequent and the LOS was longer in HIV-positive patients with CD4 counts≥200 cellsx 106/L. In a multivariable regression model, HIV-positive status was independently associated with NIPPV use (OR 2.52; 95% CI 1.43 to 4.46) and a 0.55 day (95% CI 0.02 to 1.08) longer LOS in hospital.
CONCLUSIONS
HIV-positive patients admitted with asthma exacerbation are more likely to require NIPPV and have longer LOS.
背景
有研究提示 HIV 感染者哮喘发病率增加。本研究旨在比较因哮喘急性加重住院的 HIV 阳性和 HIV 阴性患者的结局。
方法
回顾性分析 2015 年 1 月至 2017 年 12 月间因哮喘急性加重且已知 HIV 感染状况的患者。
结果
研究期间共收治 1242 例哮喘患者，其中 462 例患者 HIV 感染状况已知（358 例 HIV 阴性，104 例 HIV 阳性），纳入本研究。除 HIV 阴性患者合并充血性心力衰竭的发生率较高外，两组间基线特征（年龄、性别、体重指数、合并症）无差异。HIV 阳性组患者的血清肌酐水平[1.117（1.390）比 0.813（0.509），p=0.001]、血清嗜酸性粒细胞计数[492.91（1789.09）比 243.70（338.66），p=0.013]更高，但血清中性粒细胞计数[5.74（3.18）比 7.194（3.59），p=0.0002]和血清白蛋白水平[3.754（0.480）比 3.94（0.443），p=0.003]更低。与 HIV 阴性组相比，HIV 阳性组更常使用无创正压通气（NIPPV）[54.8%比 25.4%，p≤0.001]，住院时间更长[3.346 天比 2.813 天，p=0.015]。两组间机械通气使用率和重症监护病房入住率无差异。在按 CD4 计数分层比较 HIV 阴性与 HIV 阳性患者的亚组分析中，CD4 计数≥200 cellsx 106/L 的 HIV 阳性患者中，NIPPV 使用率更高，住院时间更长。多变量回归模型显示，HIV 阳性状态与 NIPPV 使用（OR 2.52；95%CI 1.43-4.46）和住院时间延长 0.55 天（95%CI 0.02-1.08）独立相关。
结论
因哮喘急性加重住院的 HIV 阳性患者更可能需要 NIPPV，住院时间更长。
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