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一项关于南非一家三级医院(2015 - 2019年)HIV感染状况对儿科重症监护病房收治患儿预后影响的回顾性观察研究。

A Retrospective Observational Study of the Impact of HIV Status on the Outcome of Paediatric Intensive Care Unit Admissions at a Tertiary Hospital in South Africa (2015-2019).

作者信息

Whitehead Kim, Ballot Daynia E

机构信息

Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa.

出版信息

Pediatr Rep. 2023 Nov 8;15(4):679-690. doi: 10.3390/pediatric15040061.

Abstract

HIV-infected and HIV-exposed but uninfected (HEU) children have unique health risks. Our study looked at how HIV exposure and infection impact presentation and outcomes in PICU in an era of improved ART. A retrospective analysis of children admitted to PICU was performed. The sample was divided into HIV negative, HEU and HIV infected, and presentation and outcomes were compared with a significance level set at α = 0.05. Our study showed that 16% (109/678) of children admitted to PICU were HEU and 5.2% (35/678) were HIV infected. HIV-infected children were admitted at a younger age (median two months) with an increased incidence of lower respiratory infections than HIV-negative children ( < 0.001); they also required longer ventilation and admission ( < 0.001). HIV-infected children had a higher mortality (40%) ( = 0.02) than HIV-negative (22.7%) children; this difference was not significant when comparing only children with a non-surgical diagnosis ( = 0.273). HEU children had no significant difference in duration of ICU stay ( = 0.163), ventilation ( = 0.443) or mortality ( = 0.292) compared to HIV-negative children. In conclusion, HIV-infected children presented with more severe disease requiring longer ventilation and admission. HEU had similar outcomes to HIV-negative children.

摘要

感染人类免疫缺陷病毒(HIV)以及暴露于HIV但未感染(HEU)的儿童存在独特的健康风险。我们的研究探讨了在抗逆转录病毒治疗(ART)有所改善的时代,HIV暴露和感染如何影响儿科重症监护病房(PICU)中的临床表现及治疗结果。对入住PICU的儿童进行了回顾性分析。样本被分为HIV阴性、HEU和HIV感染组,并对临床表现和治疗结果进行比较,显著性水平设定为α = 0.05。我们的研究表明,入住PICU的儿童中,16%(109/678)为HEU,5.2%(35/678)为HIV感染。与HIV阴性儿童相比,HIV感染儿童入院时年龄更小(中位数为两个月),下呼吸道感染发生率更高(<0.001);他们还需要更长时间的通气和住院(<0.001)。HIV感染儿童的死亡率(40%)(P = 0.02)高于HIV阴性儿童(22.7%);仅比较非手术诊断的儿童时,这种差异不显著(P = 0.273)。与HIV阴性儿童相比,HEU儿童在重症监护病房住院时间(P = 0.163)、通气时间(P = 0.443)或死亡率(P = 0.292)方面无显著差异。总之,HIV感染儿童表现出更严重的疾病,需要更长时间的通气和住院。HEU儿童的治疗结果与HIV阴性儿童相似。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b738/10661240/856c591446fa/pediatrrep-15-00061-g001.jpg

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