Mortality of patients infected with HIV in the intensive care unit (2005-2010): significant role of chronic hepatitis C and severe sepsis

Medrano, José; Álvaro-Meca, Alejandro; Boyer, Alexandre; Jiménez-Sousa, María Ángeles; Resino, Salvador

doi:10.1186/preaccept-1332681689119776

Cited by 11 publications

(11 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Medrano et al . in a large Spanish cohort study, evidenced that among HIV patients, mortality rates in the first seven days were higher in all groups when compared to non-HIV patients (36.5 vs. 28.8%, p < 0.001) 26 . In the present study, mortality was associated to sepsis and septic shock, the main overall causes of death in ICU patients 27 - 29 .…”

Section: Discussionmentioning

confidence: 86%

Clinical Characteristics, Outcomes and Risk Factors for Death Among Critically Ill Patients With Hiv-Related Acute Kidney Injury

Luna

Soares

Silva

et al. 2016

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

SUMMARYBackground: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death.

show abstract

Section: Discussionmentioning

confidence: 86%

Clinical Characteristics, Outcomes and Risk Factors for Death Among Critically Ill Patients With Hiv-Related Acute Kidney Injury

Luna

Soares

Silva

et al. 2016

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

show abstract

“…While various different disease processes can lead to an immunosuppressed state, we found that in particular HIV/AIDS is associated with a higher mortality. A concomitant HIV infection has also therapeutic implications as the spectrum of pathogens is different and the course of sepsis is often more severe with distinct clinical and inflammatory characteristics 16,17.…”

Section: Discussionmentioning

confidence: 99%

The SPEED (sepsis patient evaluation in the emergency department) score: a risk stratification and outcome prediction tool

Bewersdorf¹,

Hautmann²,

Kofink

et al. 2017

European Journal of Emergency Medicine

View full text Add to dashboard Cite

ObjectivesThe aim of the study was to identify covariates associated with 28-day mortality in septic patients admitted to the emergency department and derive and validate a score that stratifies mortality risk utilizing parameters that are readily available.MethodsPatients with an admission diagnosis of suspected or confirmed infection and fulfilling at least two criteria for severe inflammatory response syndrome were included in this study. Patients’ characteristics, vital signs, and laboratory values were used to identify prognostic factors for mortality. A scoring system was derived and validated. The primary outcome was the 28-day mortality rate.ResultsA total of 440 patients were included in the study. The 28-day hospital mortality rate was 32.4 and 25.2% for the derivation (293 patients) and validation (147 patients) sets, respectively. Factors associated with a higher mortality were immune-suppressed state (odds ratio 4.7; 95% confidence interval 2.0–11.4), systolic blood pressure on arrival less than 90 mmHg (3.8; 1.7–8.3), body temperature less than 36.0°C (4.1; 1.3–12.9), oxygen saturation less than 90% (2.3; 1.1–4.8), hematocrit less than 0.38 (3.1; 1.6–5.9), blood pH less than 7.35 (2.0; 1.04–3.9), lactate level more than 2.4 mmol/l (2.27; 1.2–4.2), and pneumonia as the source of infection (2.7; 1.5–5.0). The area under the receiver operating characteristic curve was 0.81 (0.75–0.86) in the derivation and 0.81 (0.73–0.90) in the validation set. The SPEED (sepsis patient evaluation in the emergency department) score performed better (P=0.02) than the Mortality in Emergency Department Sepsis score when applied to the complete study population with an area under the curve of 0.81 (0.76–0.85) as compared with 0.74 (0.70–0.79).ConclusionThe SPEED score predicts 28-day mortality in septic patients. It is simple and its predictive value is comparable to that of other scoring systems.

show abstract

“…( 3 , 4 ) Although survival in the ICU has improved since the beginning of the HIV epidemic, the mortality rate of critically ill patients is approximately 30%, which is still higher than the mortality rate in patients not infected with HIV. ( 5 , 6 )…”

Section: Introductionmentioning

confidence: 99%

Palliative care for patients with HIV/AIDS admitted to intensive care units

Souza¹,

Miranda²,

Cruz³

et al. 2016

Revista Brasileira De Terapia Intensiva

View full text Add to dashboard Cite

ObjectiveTo describe the characteristics of patients with HIV/AIDS and to compare the therapeutic interventions and end-of-life care before and after evaluation by the palliative care team.MethodsThis retrospective cohort study included all patients with HIV/AIDS admitted to the intensive care unit of the Instituto de Infectologia Emílio Ribas who were evaluated by a palliative care team between January 2006 and December 2012.ResultsOf the 109 patients evaluated, 89% acquired opportunistic infections, 70% had CD4 counts lower than 100 cells/mm3, and only 19% adhered to treatment. The overall mortality rate was 88%. Among patients predicted with a terminally ill (68%), the use of highly active antiretroviral therapy decreased from 50.0% to 23.1% (p = 0.02), the use of antibiotics decreased from 100% to 63.6% (p < 0.001), the use of vasoactive drugs decreased from 62.1% to 37.8% (p = 0.009), the use of renal replacement therapy decreased from 34.8% to 23.0% (p < 0.0001), and the number of blood product transfusions decreased from 74.2% to 19.7% (p < 0.0001). Meetings with the family were held in 48 cases, and 23% of the terminally ill patients were discharged from the intensive care unit.ConclusionPalliative care was required in patients with severe illnesses and high mortality. The number of potentially inappropriate interventions in terminally ill patients monitored by the palliative care team significantly decreased, and 26% of the patients were discharged from the intensive care unit.

show abstract

Mortality of patients infected with HIV in the intensive care unit (2005-2010): significant role of chronic hepatitis C and severe sepsis

Cited by 11 publications

References 48 publications

Clinical Characteristics, Outcomes and Risk Factors for Death Among Critically Ill Patients With Hiv-Related Acute Kidney Injury

Clinical Characteristics, Outcomes and Risk Factors for Death Among Critically Ill Patients With Hiv-Related Acute Kidney Injury

The SPEED (sepsis patient evaluation in the emergency department) score: a risk stratification and outcome prediction tool

Palliative care for patients with HIV/AIDS admitted to intensive care units

Contact Info

Product

Resources

About