In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes

Abstract

Background: Marked improvements were realized in both shortterm and long-term outcomes of human immunodeficiency virus (HIV)-infected patients following the introduction of combination antiretroviral therapy. However, the contemporary population-level patterns of in-hospital cardiopulmonary resuscitation (CPR) and the outcomes of HIV-infected patients were not systematically examined. Methods:We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without HIV during 2009 -2014, and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of HIV infection following in-hospital CPR and predictors of short-term survival among HIV hospitalizations. Results:In-hospital CPR was reported in 437 and 54,135 hospitalizations with and without HIV, respectively. The rates of in-hospital CPR (per 1,000 hospitalizations) were 4.4 and 4.1 among hospitalizations with and without HIV, respectively (P = 0.1659). The corresponding rates of in-hospital CPR among decedents were 11% and 11.8%, respectively (P = 0.1531). Crude short-term survival following in-hospital CPR among hospitalizations with and without HIV was 19% and 26.8%, respectively (P = 0.0003). The corresponding adjusted short-term survival between 2009 and 2014 rose from 14.2% to 27% (P = 0.0009 for trend) and from 25.5% to 28% (P < 0.0001 for trend). HIV infection was associated with lower odds of shortterm survival following in-hospital CPR (adjusted odds ratio (aOR): 0.50, 95% confidence interval (95% CI): 0.39 -0.65). Select comorbid conditions (congestive heart failure, aOR: 2.03, 95% CI: 1.20 -2.46; cerebrovascular disease, aOR: 2.08, 95% CI: 1.15 -3.75; and diabetes, aOR: 1.53, 95% CI 1.31 -4.71) were the only independent predictors of short-term survival following in-hospital CPR among HIV hospitalizations. Conclusions:The rates of in-hospital CPR were similar among hospitalizations with and without HIV infection, with similar level of selectivity among decedents. Although HIV infection was associated with lower short-term survival following in-hospital CPR for the whole cohort, a dramatic improvement was observed during the study period among affected patients, with short-term survival rates becoming near-similar to those without HIV. Further studies are needed to identify modifiable factors to further improve the outcomes following in-hospital CPR among patients with HIV infection.

Impacts of Symptomatic HIV Infection on In-Hospital Cardiopulmonary Resuscitation Outcomes: &#x2028;A Population-Based Cohort Study in South Korea

“…A similar study by Lavi Oud reported that the incidence of ICPR was similar among those hospitalized with and without HIV infection; however, HIV-infected patients have been shown to have lower short-term survival rates in the United States [ 13 ]. In terms of short-term survival outcomes, Oud reported findings similar to those of our study.…”

“…In terms of short-term survival outcomes, Oud reported findings similar to those of our study. Oud analyzed 437 and 54 135 patients with and without HIV, respectively, who experienced ICPR during hospitalization in the United States [ 13 ], while we analyzed 586 and 298 090 subjects in the PWH group and the control group, respectively, who experienced ICPR during hospitalization in South Korea. The findings from our study and those of Lavi Oud contradict those of a previous study by Mongardon et al, which reported that ICU mortality after cardiac arrest was not significantly affected by HIV infection among 99 patients [ 17 ].…”

“…However, a previous study by Raviglione et al analyzed a relatively small sample size of 43 patients from July 1, 1986, to June 30, 1987 [ 10 ], and the conditions of patients with HIV infection were different in the 1980s–1990s compared with the 2010s due to advances in ART [ 12 ]. Recently, Lavi Oud reported that, in the United States, short-term survival (defined as absence of hospital mortality or discharge to hospice) after ICPR was lower in patients with HIV infection than in patients without HIV infection [ 13 ]. However, Lavi Oud did not compare long-term survival outcomes after ICPR according to HIV infection.…”