Journal of Medical Virology 87:366–374 (2015)

Etiology and Outcomes for Patients Infected with HIV in Intensive Care Units in A Tertiary Care Hospital in China Jiang Xiao,1 Wen Zhang,1 Yingxiu Huang,2 Yunfei Tian,1 Wenjing Su,1 Yanmei Li,2 Wei Zhang,1 Ning Han,1 Di Yang,1 and Hongxin Zhao1 1

Beijing Ditan Hospital, Capital Medical University Beijing Ditan Hospital, Beijing University Health Science Center

2

Although the National Free Antiretroviral Treatment Program (NFATP) has resulted in a significant reduction in the incidence of AIDSdefining illnesses in China, severe complications in patients infected with HIV may require aggressive treatment and critical care support. The objective for this study was to investigate the etiology and outcomes of patients infected with HIV admitted to intensive care units in Ditan Hospital, China. The evaluation of the etiology and outcomes of patients infected with HIV admitted to intensive care units was conducted using the clinical data from 122 patients infected with HIV (129 occasions) admitted to the Beijing Ditan hospital from January 1, 2009, to October 1, 2013. Over the five-year study period, 129 occasions occurred for 122 patients infected with HIV admitted to intensive care units. Respiratory failure was the most common condition (53.4%) among the 129 occasions analyzed. This was followed by pneumothorax (12.4%), infectious shock (8.5%), neurological problems (8.5%), renal failure (7.8%), post-operative complications and trauma (5.4%), coronary heart disease (3.1%), adverse effects of HAART (3.1%), lymphoma (2.4%), and liver failure (0.8%). Mortality in intensive care units was 64.5% while in-hospital mortality was 65.9%. The strongest protective predictor for in-hospital mortality was earlier admission to an intensive care unit (OR ¼ 0.050, CI ¼ 0.020–0.126, P < 0.001). Respiratory failure was the most common condition in patients infected with HIV admitted to intensive care units, and the outcome for the patients was poor. Mortality was negatively associated with earlier admission to an intensive care unit, but was not associated with HAART. J. Med. Virol. 87:366–374, 2015. # 2014 Wiley Periodicals, Inc. C 2014 WILEY PERIODICALS, INC. 

KEY WORDS:

etiology; HIV/AIDS; critical care; HAART

INTRODUCTION The advent of the National Free Antiretroviral Treatment Program (NFATP) [Zhang et al., 2005, 2007] has resulted in a significant reduction in the incidence of AIDS-defining illnesses and a marked increase in lifespan in patients infected with HIV in China. Nevertheless, HIV-related clinical diseases (including AIDS-defining illnesses and non-AIDSdefining illnesses) continue to cause morbidity and mortality in Chinese patients infected with HIV [Xiao et al., 2013]. Some patients are diagnosed with HIV infection when opportunistic infections become the indicator of their disease [Xiao et al., 2013]; some patients infected with HIV take antiretroviral (ART) medications but experience virological and immunological failure; and other co-morbidities such as chronic kidney diseases, hepatitis B or C co-infection and cirrhosis are found in patients infected with HIV. Severe complications, including opportunistic infections Grant sponsor: The Study of Construction of Representative areas for Prevention and Therapy of Fatal Infectious Diseases such AIDS & Viral Hepatitis in Chaoyang District, Beijing; Grant number: 2012ZX10004-904.; Grant sponsor: The Twelvefifth Key Project Program for the 12th Five-year Plan; Grant number: 2012ZX10001003. Potential conflicts of interest. All authors report no conflicts of interest.  Correspondence to: Hongxin Zhao, NO. 8 Jingshun East Street, Chaoyang District, Beijing, China. 100015. E-mail: [email protected] Accepted 1 August 2014 DOI 10.1002/jmv.24063 Published online 25 August 2014 in Wiley Online Library (wileyonlinelibrary.com).

Etiology for Patients Infected with HIV in ICU

and co-morbidities, in patients infected with HIV may require aggressive treatment and critical care support. Several studies [Wachter et al., 1995; Nickas and Wachter, 2000] have suggested that, in the preHAART (highly active antiretroviral therapy) era, Pneumocystis jirovecii pneumonia (PCP) and respiratory failure were most common conditions seen in patients infected with HIV admitted to intensive care units. The introduction of HAART not only resulted in a marked reduction in opportunistic infections but also changed the conditions requiring admission to critical care units [Adlakha et al., 2011; Greenberg et al., 2012]. Several studies have shown that the common conditions in such patients are sepsis and non-AIDS-associated illnesses, and overall survival has improved in patients infected with HIV who are admitted to intensive care units since the introduction of HAART [Morris et al., 2002]. The associated prognostic factors include the use of HAART, non-AIDS-associated illnesses [Morris et al., 2002], the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum albumin levels [Powell et al., 2009], mechanical ventilation [Powell et al., 2009], lower CD4 cell counts and late diagnosis of HIV [Shrosbree et al., 2013]. The above studies mainly involved Euro-American patients infected with HIV, and the etiology and outcomes in Chinese patients infected with HIV admitted to intensive care units have rarely been reported. The Beijing Ditan Hospital is a tertiary care hospital in China, which provides high-quality care and treatment to patients with HIV/AIDS, including those admitted to intensive care units. The objective for this study was to investigate the etiology and outcomes of patients infected with HIV who were admitted to intensive care units in Ditan Hospital. MATERIALS AND METHODS This analysis was approved by the institutional review board (IRB) of Ditan Hospital, the Capital Medical University, Beijing. As recommended in the IRB review, individual informed consent was waived because this analysis used the currently existing data collected during the course of routine treatment and care. The data were reported in aggregate. Participants This retrospective observational study was carried out at the Centers for Infectious Diseases and Intensive Care Units, Beijing Ditan Hospital, the largest designated tertiary care hospital for patients with HIV/AIDS in North China. We reviewed patients infected with HIV who were admitted to intensive care units in Beijing Ditan Hospital between January 1, 2009 and October 1, 2013. HIV infection was either diagnosed initially or already known while the patients were in the intensive care units. Electronic medical records were reviewed and clinical information was abstracted for those patients admit-

367

ted to intensive care units. For patients who were admitted to intensive care units more than once during their hospitalization, repeat intensive care unit admissions were considered as separate events. Diagnosis of Diseases and Etiology in HIVInfected Patients Admitted to Intensive Care Units [Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents, 2013] Pneumocystis pneumonia (PCP) was diagnosed from compatible clinical symptoms such as a subacute onset of progressive dyspnea, fever, nonproductive cough, and hypoxemia. Computerized tomography (CT) scan demonstrated patchy ground-glass attenuation. Induced sputum and bronochoalveolar lavage fluid (BALF) samples were collected to stain the cyst wall with Gomori methenamine silver. Spontaneous pneumothorax in patients with pneumocystis pneumonia was confirmed on the basis of the chest radiographic presentation. Severe pneumonia represented severe infection in the respiratory system with unknown etiology and may have involved co-infection with bacteria, pulmonary tuberculosis or fungi, based on compatible clinical symptoms, signs and CT scan findings. Neurological problems were diagnosed from the clinical symptoms and focal neurological abnormalities, pathogen identification in cerebrospinal fluid (CSF), and identification of one or more mass lesions, hemorrhage or infarction by CT scan or magnetic resonance imaging (MRI) of the brain. Lymphomas were diagnosed on the basis of their characteristic pathological demonstration. Serum lactate levels and pH were measured in symptomatic patients taking Stavudine who complained of fatigue, abdominal disturbances, nausea, vomiting, or sudden dyspnea. Lactic acidosis was confirmed based on pH

Etiology and outcomes for patients infected with HIV in intensive care units in a tertiary care hospital in China.

Although the National Free Antiretroviral Treatment Program (NFATP) has resulted in a significant reduction in the incidence of AIDS-defining illnesse...
212KB Sizes 1 Downloads 8 Views