Cavalcante Malena Gadelha, Parente Matheus de Sá Roriz, Gomes Pedro Eduardo Andrade de Carvalho, Meneses Gdayllon Cavalcante, Silva Júnior Geraldo Bezerra da, Pires Neto Roberto da Justa, Daher Elizabeth De Francesco
Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, Ceará, Brazil.
Universidade de Fortaleza, Curso de Medicina, Fortaleza, Ceará, Brazil.
Rev Inst Med Trop Sao Paulo. 2021 Apr 23;63:e33. doi: 10.1590/S1678-9946202163033. eCollection 2021.
HIV-infected patients are at high risk for developing critical diseases, including opportunistic infections (OI), with consequent admission in intensive care units (ICU). Renal disfunctions are risk factors for death in HIV/AIDS patients, and survival rates in patients undergoing hemodialysis are smaller than the ones observed in the general population. In this context, this study aimed to investigate death-related factors in HIV/AIDS patients in an intensive care setting. This is a retrospective cross-sectional study performed through the analysis of medical records from 271 HIV/AIDS-diagnosed patients hospitalized in an intensive care unit of an infectious disease hospital, in Fortaleza, Ceara State, Brazil. Patients were divided into two groups: those who underwent dialysis during hospitalization and those who did not. Clinical and demographic parameters that could be associated with death were evaluated. Results indicated a prevalence of death of 19.1% (CI 95%: 14.8-24.3). The median age of patients was 47 years, with a male predominance (71.3%). The main causes of admission were pulmonary tuberculosis (16.9%), followed by neurotoxoplasmosis (14.9%). In the bivariate analysis, for those that did not undergo dialysis, age, fever, dyspnea, oliguria, disorientation, kidney injury, use of lamivudine and efavirenz, length of hospitalization, CD4 count, WBC count, platelet count, urea, sodium and LDH levels were the associated variables. In those who needed dialysis, the use of stavudine, abacavir and ritonavir, and the length of hospitalization were associated factors. Renal toxicity by the antiretroviral agents and length of hospitalization increased the risk of death among HIV patients under dialysis.
感染艾滋病毒的患者极易患上严重疾病，包括机会性感染（OI），进而需要入住重症监护病房（ICU）。肾功能障碍是艾滋病毒/艾滋病患者死亡的危险因素，接受血液透析的患者的生存率低于普通人群。在此背景下，本研究旨在调查重症监护环境下艾滋病毒/艾滋病患者的死亡相关因素。这是一项回顾性横断面研究，通过分析巴西塞阿拉州福塔莱萨市一家传染病医院重症监护病房收治的271例确诊为艾滋病毒/艾滋病患者的病历进行。患者分为两组：住院期间接受透析的患者和未接受透析的患者。评估了可能与死亡相关的临床和人口统计学参数。结果显示死亡率为19.1%（95%置信区间：14.8 - 24.3）。患者的中位年龄为47岁，男性占主导（71.3%）。入院的主要原因是肺结核（16.9%），其次是神经弓形虫病（14.9%）。在双变量分析中，对于未接受透析的患者，年龄、发热、呼吸困难、少尿、定向障碍、肾损伤、拉米夫定和依非韦伦的使用、住院时间、CD4细胞计数、白细胞计数、血小板计数、尿素、钠和乳酸脱氢酶水平是相关变量。在需要透析的患者中，司他夫定、阿巴卡韦和利托那韦的使用以及住院时间是相关因素。抗逆转录病毒药物引起的肾毒性和住院时间增加了接受透析的艾滋病毒患者的死亡风险。
