Rafael Perelló1, Ona Escoda2, Silvia Camón2, Òscar Miró2, Marta Castañeda2, Asunción Moreno3, Maria Ángeles Marcos4, Verónica Perea2, Natalia Alcolea2, Miquel Sánchez2, Josep Maria Gatell3, Esteban Martínez3. 1. Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain. Electronic address: rperello@clinic.ub.es. 2. Emergency Department, Hospital Clínic, "Emergency Care: Processes and Pathologies" Research Group, IDIBAPS, Barcelona, Spain. 3. Department of Infectious Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Spain. 4. Department of Microbiology, Hospital Clínic, Barcelona Centre for International Health Research (CRESIB, Hospital Clínic - University of Barcelona), Spain.
Abstract
AIM: To describe the incidence, the changes in the etiology and the prognosis of lower respiratory tract infection (LRTI) in HIV infected patients, presenting by the first time to the Emergency Department (ED), during years 2000-2010. STUDY DESIGN: Prospective collection of data. METHODS: Data were collected on the first visit of HIV-infected patients at our ED due to a LRTI, (defined according to the criteria of the European Respiratory Society), between 1/1/2000 and 31/12/2010. A series of epidemiological and laboratory variables as well as the need for admission to the intensive care unit (ICU). LRTI etiology were also collected. The influence ofthe mentioned variables on 30-day mortality were analyzed. RESULTS: One hundred thirty one patients were included. LRTI represented 27% of visits to the ED by HIV-infected patients. Mean age was 39±9 years. 72% of patients were males. 18% required admission to the ICU. The most frequent LRTI was pneumonia by P. jiroveci in 35 cases, bacterial penumonia in 27 and pulmonary tuberculosis in 20. LRTI incidence gradually reduced significantly over time from 6.13 × 1000 patients/year in year 2000 to 0.23 × 1000 patients/year in 2010 (p<0.05). Overall mortality was 14%. Logistic regression analysis showed that admission to ICU (p<0.004) and viral load (p<0.029) were independent variables predicting mortality. CONCLUSION: LRTI is a pathology with a decreasing incidence, probably related to the widespread utilization increased of HAART regimens. lts etiology has also been changing, but with a non negligible mortality, mostly when ICU admission was required.
AIM: To describe the incidence, the changes in the etiology and the prognosis of lower respiratory tract infection (LRTI) in HIV infectedpatients, presenting by the first time to the Emergency Department (ED), during years 2000-2010. STUDY DESIGN: Prospective collection of data. METHODS: Data were collected on the first visit of HIV-infectedpatients at our ED due to a LRTI, (defined according to the criteria of the European Respiratory Society), between 1/1/2000 and 31/12/2010. A series of epidemiological and laboratory variables as well as the need for admission to the intensive care unit (ICU). LRTI etiology were also collected. The influence ofthe mentioned variables on 30-day mortality were analyzed. RESULTS: One hundred thirty one patients were included. LRTI represented 27% of visits to the ED by HIV-infectedpatients. Mean age was 39±9 years. 72% of patients were males. 18% required admission to the ICU. The most frequent LRTI was pneumonia by P. jiroveci in 35 cases, bacterial penumonia in 27 and pulmonary tuberculosis in 20. LRTI incidence gradually reduced significantly over time from 6.13 × 1000 patients/year in year 2000 to 0.23 × 1000 patients/year in 2010 (p<0.05). Overall mortality was 14%. Logistic regression analysis showed that admission to ICU (p<0.004) and viral load (p<0.029) were independent variables predicting mortality. CONCLUSION: LRTI is a pathology with a decreasing incidence, probably related to the widespread utilization increased of HAART regimens. lts etiology has also been changing, but with a non negligible mortality, mostly when ICU admission was required.
Keywords:
Emergency department; Human immunodeficiency virus; Neumonía; P. jirovecii; Pneumonia; Servicio de Urgencias; Virus de la inmunodeficiencia humana