Impact of HIV/AIDS on care and outcomes of severe sepsis

Abstract

IntroductionThere has been dramatic improvement in survival for patients with HIV/AIDS; however, some studies on patients with HIV/AIDS and serious illness have reported continued low rates of intensive care. The purpose of this study was to examine patterns of care and outcomes for patients with severe sepsis and HIV/AIDS and compare them with those of patients with severe sepsis without HIV/AIDS.MethodsWe assessed data from all 1999 discharge abstracts from all non-federal hospitals in six US states. Patient demographic characteristics, discharge diagnoses, resource use, and outcomes were extracted. Analyses were performed using chi-square, Wilcoxon rank sum, or regression techniques, as appropriate.ResultsWe identified 74,020 patients with severe sepsis (7,638 (10.3%) had HIV/AIDS) using ICD-9-CM codes. Patients with severe sepsis and HIV/AIDS had a similar mean length of stay (16.9 days versus 17.7 days; p = 0.0669), had lower mean hospitalization cost ($24,382 versus $30,537; p < 0.0001), were less likely to be admitted to the intensive care unit (37% versus 56%; p < 0.0001), and had a greater mortality (29% versus 20%; p < 0.0001) than those without HIV/AIDS. After adjustment for cohort differences, patients with severe sepsis and HIV/AIDS had increased likelihood of death (OR (95% CI) = 2.41 (2.23–2.61)) and were substantially less likely to be admitted to the intensive care unit (OR (95% CI) = 0.54 (0.51–0.59)). When compared with those with severe sepsis and HIV/AIDS, patients with severe sepsis without HIV/AIDS were universally more likely to be admitted to the intensive care unit, even when they had comorbid illnesses with equal or worse expected in-hospital mortality (e.g., metastatic cancer).ConclusionFor patients with severe sepsis, there are differences in care and outcomes for those with HIV/AIDS. Further research is needed to examine the delivery of care for patients with severe sepsis and HIV/AIDS.

Benefit of antiretroviral therapy on survival of human immunodeficiency virus-infected patients admitted to an intensive care unit

“…HIV-infected patients with sepsis had significantly higher mortality rates than those with respiratory failure (76.9% and 57.8%, respectively, p = 0.01). Previous studies have highlighted the impact of sepsis in critically ill HIV-infected patients (16, 30–34), especially in developing countries (18). Our results reinforce the importance of sepsis diagnosis in this population.…”

“…The rates of intensive care unit (ICU) admissions have also changed, especially for the spectrum of non–acquired immunodeficiency syndrome (AIDS)-associated illnesses as initial diagnoses (6, 8, 10–12). Although respiratory failure associated with Pneumocystis jirovecii pneumonia is still the most frequent reason for ICU admission, non–AIDS-associated illnesses are now becoming more common, including bacterial pneumonia and sepsis, hepatic insufficiency, cardiovascular diseases, neoplasm, and complications of chemotherapy (6, 9–11, 13–16). …”

The effect of HIV status on clinical outcomes of surgical sepsis in KwaZulu-Natal Province, South Africa

“…[7][8][9] In HIV-infected patients, sepsis accounted for 12 -31% of HIV-positive patients' admission to intensive care units (ICUs), and was associated with a worse prognosis. [7][8][9][10] Despite the significant prevalence of the disease in KZN, the impact of HIV co-infection on the clinical outcome of surgical patients in our setting remains largely unknown. Over a decade ago, and prior to the national roll-out of the HAART programme, a study by Cacala et al [2] showed that HIV status does not influence the clinical outcome in general surgical patients.…”

“…This is in contrast to the documented poorer outcome of sepsis in HIV-infected patients. [7][8][9][10] In these studies, no differentiation is made between patients with surgical sepsis and those without.…”

Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia

“…Gender, diabetes, immunosuppression, and cancer are among the factors associated with these increases. It is therefore arguable that the frequency of sepsis and its impact on clinical outcomes will continue to increase (38)(39)(40)(41)(42)(43)(44)(45). On the other hand, statistics can vary according to the criteria by which diseases are defined from an epidemiological standpoint (46,47).…”