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

Green, Samantha; Kong, Victor; Odendaal, Jocinta; Sartorius, Benn; Clarke, Damian; Brysiewicz, Petra; Bruce, J L; Laing, G L; Bekker, W

doi:10.7196/samj.2017.v107i8.12045

Cited by 12 publications

(19 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is despite the large proportion of HIV‐positive patients (82%) in this study with a detectable viral load. Similar to our findings, a study that compared the effects of HIV status on clinical outcomes of surgical sepsis in the KwaZulu‐Natal Province of South Africa did not report significant differences in clinical presentation, spectrum of surgical disease or morbidity/mortality . Weledji et al concluded that patients with HIV/AIDS should not be regarded as a homogenous group and that the best predictors of peri‐operative morbidity and mortality are scores that measure general health, such as the American Society of Anesthesiologist (ASA) risk score .…”

Section: Discussionsupporting

confidence: 88%

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

2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 88%

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

2019

View full text Add to dashboard Cite

show abstract

“…[8][9][10] Studies from Africa have also showed similar conflicting results. [11][12][13] A recent large multinational prospective cohort study also did not show poor outcomes among HIV-infected patients. 14 Studies have also differed in the patient populations, with some studies focussing solely on cardiac surgery, 11 anorectal surgeries, 12 orthopaedic surgeries, 13 etc.…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes in human immunodeficiency virus-infected patients – the PRO HIV study

et al. 2018

View full text Add to dashboard Cite

It is estimated that a quarter of patients with HIV/AIDS undergo at least one surgical procedure in their life time. Surgical outcomes in these patients from developing countries are poorly characterized and surgeons are often concerned about poor surgical outcomes, especially when their CD4 cell counts are less than 200 cells/µl. This study evaluated the surgical outcomes of HIV-infected patients undergoing various surgical procedures over a six-year period in a large tertiary care hospital from South India. Two hundred and ninety-three patients underwent 374 surgical procedures during the study period. The median duration of HIV prior to surgery was 1.9 years (range 0-18.8 years). Two-thirds (58%) were on highly active antiretroviral therapy (HAART) at the time of surgery with the median duration of this treatment being 38 months (n = 194). About one-third (35%) of surgical procedures were performed as an emergency. Abdomino-pelvic surgeries were the most common (225, 60%). Adverse surgical outcome defined as death or post-operative infection was seen in 25 (6.6%). The post-operative infection rate was 5% (20/374). The most common of these was surgical site infection observed in nine (60%) followed by pneumonia in five patients (33%) and urinary tract infection in one patient. Day 30 mortality was 2% (n = 8) and a quarter of these were reported to be related to post-operative infectious complications. On multivariate analysis, only preoperative haemoglobin of less than 10 g/dl was significantly associated with a poor surgical outcome. HIV-related parameters such as CD4 cell counts, duration of HIV infection and HAART regimen did not seem to contribute towards an adverse surgical outcome.

show abstract

“…In overall hospital mortality models, further adjustment for duration of care was performed to control for temporal trends in sepsis outcomes [15,42]. Analyses were performed for the overall study population and, as HIV impacts mortality outcomes in LMICs, analyses were performed separately for HIV uninfected and HIV infected cases as pre-planned subgroups [23,24,43]. Due to the multiple models developed, a pre-defined significance level of p b 0.005 was used [34].…”

Section: Materials and Thethodsmentioning

confidence: 99%

“…Furthermore, the clinical utility of the qSOFA score in HIV-infected patients, which are more prevalent in LMICs [21], commonly suffer from distinct infectious etiologies (i.e. fungal and mycobacteria), have altered and impaired immune response mechanisms [22] and have higher mortality from sepsis [23–26], has been minimally studied [19]. Compounding these gaps in the evidence, there is no research evaluating ED-specific outcomes from sepsis in LMICs from sub-Saharan Africa (SSA), where mortality risks are up to 100 fold greater than in HIC EDs [8,27], and as such representing a population with a great margin for benefit from rapid and appropriate identification of the highest risk sepsis patients.…”

Section: Introductionmentioning

confidence: 99%

Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country

Aluisio

Garbern

Wiskel

et al. 2018

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

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

Cited by 12 publications

References 14 publications

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

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

Perioperative outcomes in human immunodeficiency virus-infected patients – the PRO HIV study

Mortality outcomes based on ED qSOFA score and HIV status in a developing low income country

Contact Info

Product

Resources

About