Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

Abstract

Objective Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper, we herein describe clinical characteristics, laboratory findings, causes of clinical deterioration, and risk factors associated with mortality among HIV-1 patients within six months after hospital admission. Methods We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality. Results A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis, tuberculosis, cytomegaloviremia, and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts, hypoalbuminemia, anemia, hyponatremia, as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ Tcell counts as well as low creatinine, hemoglobin, albumin, and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI), p=0.049], hyponatremia (OR: 3.027; 95% CI, p=0.015), and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI, 1.200-75.065; p=0.033) within the first six months of admission. Conclusion Special consideration should be given to patients who have active tuberculosis, are at clinical stage 4, and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.

Correlation of baseline hormonal disorders with immunological failure and mortality in male HIV patients during follow-up

“…It is noted that hyponatremia, tuberculosis, and being at WHO stage 4 were associated with long-term mortality, a finding that is consistent with those from our previous short-term mortality study. [25] Although hyponatremia is a common abnormality in patients with adrenal insufficiency, we did not find any correlation between cortisol levels and hyponatremia in this study. During severe illness, sustained hypercortisolism, as opposed to significant DHEA-S depletion, could theoretically result in an imbalance between the immunosuppressive and immunostimulatory pathways [26] and, therefore, play a role in increasing susceptibility to infectious complications.…”

Clinical spectrum of renal disease in hospitalized HIV/AIDS patients: A teaching hospital experience

“…Severe hyponatremia, unlike other electrolyte disorder, is associated with a lower CD4 count. [2628] This may be the plausible reason behind association of hyponatremia with higher morbidity and mortality in HIV patients. There was a significant negative correlation of CD4 count with proteinuria in our study, similar to prior studies.…”

Hyponatremia is a marker of disease severity in HIV-infected patients: a retrospective cohort study

“…This study had a limited follow-up of one year after initiation of antiretroviral therapy in patients with a high mortality (8%) mainly due to tuberculosis (32%). More recently a prospective cohort study of 141 hospitalized patients with advanced stages of HIV infection in China showed that baseline hyponatremia was present in 28.4% of patients and independently associated with three-fold increase of death within six months after admission [ 27 ]. In this study, 72.9% of patients had advanced HIV disease [World Health Organization (WHO) stage 4] and 21.3% of patients died during the first six months of admission which is higher than the short-term mortality rates in other studies [ 29 ].…”