Patterns of presentation and survival of HIV‐infected patients admitted to a tertiary‐level intensive care unit

Abstract

ObjectivesCompared to other countires internationally, South Africa has the largest number of people living with HIV. There are limited data in developing countries on the outcomes of HIV-infected patients in the intensive care unit (ICU). The objectives of this study were to describe the pattern of presentation of these patients and to determine factors that may influence survival to ICU discharge. MethodsThe medical charts of 204 consecutive HIV-infected individuals who were admitted to the Charlotte Maxeke Johannesburg Academic Hospital adult general ICU during the calendar year 2017 were retrospectively reviewed. Relevant data were subjected to univariate and multivariate analysis. ResultsTwo-hundred and four (22.6%) out of a total of 903 patients who were admitted to the ICU were HIV positive. Sepsis-related illnesses were the most common reason for ICU admission (n = 95; 46.6%), followed by post-operative care (n = 69; 33.8%) and non-sepsis-related illnesses (n = 40; 19.6%). The median length of stay in the ICU was 5 (interquartile range 2-9) days. ICU mortality was 33.3% (n = 68). On univariate analysis, age (P = 0.039), length of stay in the ICU (P = 0.040), primary diagnostic category (P < 0.05), sepsis acquired during the ICU stay (P = 0.012), inotrope/ vasopressor administration (P < 0.001), mechanical ventilation (P < 0.001), haemodialysis (P = 0.001), CD4 cell count (P = 0.011), Acute Physiology and Chronic Health Assessment (APACHE) II score (P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (P < 0.001) were significantly associated with mortality. ConclusionsAge, diagnostic category, sepsis acquired during the ICU stay, inotrope/vasopressor administration, mechanical ventilation, haemodialysis, CD4 cell count, APACHE II score, SOFA score and length of ICU stay were associated with ICU mortality in HIV-infected patients.

Profile of presentation of HIV-positive patients to an emergency department in Johannesburg, South Africa

“…29 With regard to other significant study findings, the relatively high number of participants with an elevated CRP (84.5%), hypoalbuminemia (60.8%), hyperlactatemia (42%), thrombocytopaenia (19.9%) and a high qSOFA score (17.5%) is in line with the large number of participants presenting with severe illnesses. Previous studies have shown that elevated CRP, 31 albuminemia, 32 hyperlactatemia, 33 thrombocytopaenia 34 and higher qSOFA scores 35,36 were predictors of mortality and poor outcomes in HIV-positive individuals.…”

Development and internal validation of the HIV In‐hospital Mortality Prediction (HIV‐IMP) risk score

“…Of the three remaining variables, lactate also relates to the acuity of presenting illness while ART non‐adherence or not yet on ART and albumin predominantly relate to HIV disease control and chronicity. In a study that investigated outcomes in HIV‐positive patients admitted to a tertiary‐level hospital ICU, the APACHE II score was shown to overestimate mortality by approximately two‐fold [30].…”

Predictors of in‐hospital mortality among HIV‐positive patients presenting with an acute illness to the emergency department

“…Previous studies conducted in both outpatient and inpatient non-emergency department (ED) settings have indicated that various clinical and laboratory parameters such as the presenting diagnosis, requiring admission to the intensive care unit (ICU), a low CD 4 cell count, an elevated HIV viral load (VL), anaemia, renal dysfunction, albuminaemia, hyperlactataemia etc. have been associated with a higher likelihood of mortality in HIV-positive patients [8][9][10][11][12][13]. However, there is a lack of data emanating from the ED setting.…”