Kiruddu National Referral Hospital, Kampala, P.O. BOX 6588, Uganda.
Makerere University Joint AIDS Program, Kampala, Uganda.
BMC Infect Dis. 2024 Feb 22;24(1):239. doi: 10.1186/s12879-024-09112-7.
Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda.
We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality.
Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31-49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25-343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1-7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13-1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33-1.91, p < 0.001; undocumented CD4 + cell count status 2.08, 95%CI 1.73-2.50, p < 0.001; impaired function status 7.35, 95%CI 6.42-8.41, p < 0.001; COVID-19 1.70, 95%CI 1.22-2.37, p 0.002; liver disease 1.77, 95%CI 1.36-2.30, p < 0.001; co-infections 1.53, 95%CI 1.32-1.78, p < 0.001; home address > 20 km from hospital 1.23, 95%CI 1.04-1.46, p 0.014; hospital readmission 0.7, 95%CI 0.56-0.88, p 0.002; chronic lung disease 0.62, 95%CI 0.41-0.92, p 0.019; and neurologic disease 0.46, 95%CI 0.32-0.68, p < 0.001.
One in four admitted PLHIV die during hospitalization. Identification of risk factors (such as ART interruption, function impairment, low/undocumented CD4 + cell count), early diagnosis and treatment of co-infections and liver disease could improve outcomes.
在资源有限的环境中，艾滋病毒感染者（PLHIV）的住院治疗结局研究较少。我们描述了乌干达一家三级公立 医院住院的 PLHIV 的院内死亡率和相关临床人口统计学因素。
我们对 2020 年 3 月至 2023 年 3 月期间在基鲁杜国家转诊医院住院的 PLHIV 的常规收集数据进行了横断面分析。我们估计了住院期间死亡的 PLHIV 比例，并进行了 logistic 回归模型分析，以确定死亡率的预测因素。
在 5827 名住院 PLHIV 中，中位年龄为 39 岁（四分位距 [IQR] 31-49），3293 名（56.51%）为女性。中位 CD4+细胞计数为 109 个/µL（IQR 25-343）。入院时，3710 名（63.67%）正在接受抗逆转录病毒治疗（ART）；1144 名（19.63%）中断 ART 治疗超过 3 个月，973 名（16.70%）为初次接受 ART 治疗。院内死亡率为 26%（1524 人），中位死亡时间为 3 天（IQR 1-7）。与死亡相关的因素（调整后的优势比）包括 ART 中断，1.33，95%置信区间（CI）1.13-1.57，p 0.001；CD4+细胞计数≤200 个/µL 1.59，95%CI 1.33-1.91，p<0.001；未记录的 CD4+细胞计数状态 2.08，95%CI 1.73-2.50，p<0.001；功能受损状态 7.35，95%CI 6.42-8.41，p<0.001；COVID-19 1.70，95%CI 1.22-2.37，p 0.002；肝脏疾病 1.77，95%CI 1.36-2.30，p<0.001；合并感染 1.53，95%CI 1.32-1.78，p<0.001；家庭住址距医院>20 公里 1.23，95%CI 1.04-1.46，p 0.014；医院再入院 0.7，95%CI 0.56-0.88，p 0.002；慢性肺部疾病 0.62，95%CI 0.41-0.92，p 0.019；和神经系统疾病 0.46，95%CI 0.32-0.68，p<0.001。
四分之一的住院 PLHIV 在住院期间死亡。确定风险因素（如 ART 中断、功能损害、低/未记录的 CD4+细胞计数）、早期诊断和治疗合并感染和肝脏疾病，可以改善预后。
