Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients

Abstract

IntroductionNew challenges have arisen for the management of critically ill HIV/AIDS patients. Severe sepsis has emerged as a common cause of intensive care unit (ICU) admission for those living with HIV/AIDS. Contrastingly, HIV/AIDS patients have been systematically excluded from sepsis studies, limiting the understanding of the impact of sepsis in this population. We prospectively followed up critically ill HIV/AIDS patients to evaluate the main risk factors for hospital mortality and the impact of severe sepsis on the short- and long-term survival.MethodsAll consecutive HIV-infected patients admitted to the ICU of an infectious diseases research center, from June 2006 to May 2008, were included. Severity of illness, time since AIDS diagnosis, CD4 cell count, antiretroviral treatment, incidence of severe sepsis, and organ dysfunctions were registered. The 28-day, hospital, and 6-month outcomes were obtained for all patients. Cox proportional hazards regression analysis measured the effect of potential factors on 28-day and 6-month mortality.ResultsDuring the 2-year study period, 88 HIV/AIDS critically ill patients were admitted to the ICU. Seventy percent of patients had opportunist infections, median CD4 count was 75 cells/mm3, and 45% were receiving antiretroviral therapy. Location on a ward before ICU admission, cardiovascular and respiratory dysfunctions on the first day after admission, and the presence of severe sepsis/septic shock were associated with reduced 28-day and 6-month survival on a univariate analysis. After a multivariate analysis, severe sepsis determined the highest hazard ratio (HR) for 28-day (adjusted HR, 3.13; 95% CI, 1.21-8.07) and 6-month (adjusted HR, 3.35; 95% CI, 1.42-7.86) mortality. Severe sepsis occurred in 44 (50%) patients, mainly because of lower respiratory tract infections. The survival of septic and nonseptic patients was significantly different at 28-day and 6-month follow-up times (log-rank and Peto test, P < 0.001).ConclusionsSevere sepsis has emerged as a major cause of admission and mortality for hospitalized HIV/AIDS patients, significantly affecting short- and longer-term survival of critically ill HIV/AIDS patients.

Przyczyny hospitalizacji chorych zakażonych wirusem HIV na oddziale intensywnej terapii — jednoośrodkowe badanie obserwacyjne

“…The mortality in this group was found to be more dependent on such factors as sepsis or increased organ/system dysfunction than on HIV/AIDS-associated factors, i.e. the level of resistance, use of HAART therapy or time from AIDS diagnosis [12]. To date, only a few studies evaluated prospectively the factors affecting survival of septic patients with HIV/AIDS [12].…”

“…the level of resistance, use of HAART therapy or time from AIDS diagnosis [12]. To date, only a few studies evaluated prospectively the factors affecting survival of septic patients with HIV/AIDS [12]. Analysis of a large US database has revealed that septic patients infected with HIV are less frequently hospitalised in ICUs, compared to septic patients uninfected with HIV [13].…”

Sepsis in HIV-positive patients. What is the scale of the problem and how to approach it?

“…The leading pathogens were: Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter sp., Escherichia coli, Acinetobacter, Serratia marcescens, Staphylococ cus sp., and Mycobacterium tuberculosis. By using a Cox proportional hazards regression, a 4 times higher risk of death at 28 days was obtained in septic patients than for non-septic patients [5].…”

“…Similarly, a prospective study conducted by Japiassu et al showed that ART use did not affect hospital survival, leaving the mortality rate at 50% both in those who received ART and those who did not [5]. A Taiwanese univariable analysis of hospital mortality for HIV-positive patients showed no difference between survivors and non-survivors with respect to ART use prior to the hospital admission (p = 0.5) or to the introduction of ART at admission (p = 0.9) [21].…”

“…There are no data about sepsis in developing countries [4]. One percent to 10% of patients with sepsis have HIV/AIDS and about 12-31% of admissions of HIV-infected patients to the intensive care unit (ICU) are due to sepsis [5,6].…”