Oud Lavi
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, 701 W. 5th St., Odessa, TX 79763, USA. Email:
J Clin Med Res. 2020 Apr;12(4):233-242. doi: 10.14740/jocmr4108. Epub 2020 Mar 30.
Marked improvements were realized in both short-term and long-term outcomes of human immunodeficiency virus (HIV)-infected patients following the introduction of combination antiretroviral therapy. However, the contemporary population-level patterns of in-hospital cardiopulmonary resuscitation (CPR) and the outcomes of HIV-infected patients were not systematically examined.
We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without HIV during 2009 - 2014, and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of HIV infection following in-hospital CPR and predictors of short-term survival among HIV hospitalizations.
In-hospital CPR was reported in 437 and 54,135 hospitalizations with and without HIV, respectively. The rates of in-hospital CPR (per 1,000 hospitalizations) were 4.4 and 4.1 among hospitalizations with and without HIV, respectively (P = 0.1659). The corresponding rates of in-hospital CPR among decedents were 11% and 11.8%, respectively (P = 0.1531). Crude short-term survival following in-hospital CPR among hospitalizations with and without HIV was 19% and 26.8%, respectively (P = 0.0003). The corresponding adjusted short-term survival between 2009 and 2014 rose from 14.2% to 27% (P = 0.0009 for trend) and from 25.5% to 28% (P < 0.0001 for trend). HIV infection was associated with lower odds of short-term survival following in-hospital CPR (adjusted odds ratio (aOR): 0.50, 95% confidence interval (95% CI): 0.39 - 0.65). Select comorbid conditions (congestive heart failure, aOR: 2.03, 95% CI: 1.20 - 2.46; cerebrovascular disease, aOR: 2.08, 95% CI: 1.15 - 3.75; and diabetes, aOR: 1.53, 95% CI 1.31 - 4.71) were the only independent predictors of short-term survival following in-hospital CPR among HIV hospitalizations.
The rates of in-hospital CPR were similar among hospitalizations with and without HIV infection, with similar level of selectivity among decedents. Although HIV infection was associated with lower short-term survival following in-hospital CPR for the whole cohort, a dramatic improvement was observed during the study period among affected patients, with short-term survival rates becoming near-similar to those without HIV. Further studies are needed to identify modifiable factors to further improve the outcomes following in-hospital CPR among patients with HIV infection.
在引入联合抗逆转录病毒疗法后，人类免疫缺陷病毒（HIV）感染患者的短期和长期预后都有了显著改善。然而，目前尚未对当代住院患者中进行心肺复苏（CPR）的人群水平模式以及HIV感染患者的预后进行系统研究。
我们使用德克萨斯州住院患者公共使用数据文件，确定2009年至2014年期间年龄≥18岁的有HIV感染和无HIV感染的住院患者，以及每组中接受过院内心肺复苏的患者。对院内心肺复苏后的短期生存情况（定义为无医院死亡或转至临终关怀机构）进行了检查。采用多因素逻辑回归模型评估院内心肺复苏后HIV感染对预后的影响以及HIV住院患者短期生存的预测因素。
分别有437例有HIV感染和54135例无HIV感染的住院患者报告接受了院内心肺复苏。有HIV感染和无HIV感染的住院患者中，院内心肺复苏率（每1000例住院患者）分别为4.4和4.1（P = 0.1659）。死亡患者中相应的院内心肺复苏率分别为11%和11.8%（P = 0.1531）。有HIV感染和无HIV感染的住院患者在院内心肺复苏后的粗短期生存率分别为19%和26.8%（P = 0.0003）。2009年至2014年期间，相应的调整后短期生存率从14.2%升至27%（趋势P = 0.0009），无HIV感染组从25.5%升至28%（趋势P < 0.0001）。HIV感染与院内心肺复苏后短期生存几率较低相关（调整后的优势比（aOR）：0.50，95%置信区间（95%CI）：0.39 - 0.65）。在HIV住院患者中，某些合并症（充血性心力衰竭，aOR：2.03，95%CI：1.20 - 2.46；脑血管疾病，aOR：2.08，95%CI：1.15 - 3.75；糖尿病，aOR：1.53，95%CI 1.31 - 4.71）是院内心肺复苏后短期生存的唯一独立预测因素。
有HIV感染和无HIV感染的住院患者中，院内心肺复苏率相似，死亡患者中的选择水平也相似。尽管HIV感染与整个队列中院内心肺复苏后的短期生存率较低相关，但在研究期间，受影响患者的短期生存率显著提高，接近无HIV感染患者的水平。需要进一步研究以确定可改变的因素，以进一步改善HIV感染患者院内心肺复苏后的预后。
