Freny J Nirappil1, Ana Maheshwari2, Joel Andrews3, Greg S Martin3, Annette M Esper3, Sushma K Cribbs4. 1. Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai University, New York, NY. Electronic address: freny.nirappil@mountsinai.org. 2. Department of Internal Medicine, Mercy Catholic Medical Center, Philadelphia, PA. 3. Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA. 4. Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, GA; Pulmonary Medicine, Department of Veterans Affairs Medical Center, Atlanta, GA.
Abstract
PURPOSE: We determined the prevalence of risk factors for the development of acute respiratory distress syndrome (ARDS), outcomes of critical illness, and the impact of highly active antiretroviral therapy in HIV-1-infected patients. We hypothesized that in an urban county hospital, HIV-1-infected patients with ARDS would have a higher mortality than their HIV-1-uninfected counterparts. MATERIALS AND METHODS: Subjects were enrolled between 2006 and 2012. Baseline patient demographics, comorbidities, illness severity, causes of ARDS, and clinical outcomes were obtained. The primary end point was hospital mortality. RESULTS: A total of 178 subjects with ARDS were enrolled in the study; 40 (22%) were infected with HIV-1. The median CD4 count was 75 (15.3-198.3), and 25% were on highly active antiretroviral therapy. HIV-1-infected subjects were significantly younger (44 vs 52 years; P < .01) and had higher rates of asthma, chronic obstructive pulmonary disease, pneumonia, history of hospital-acquired infections, and prior sepsis. HIV-1-infected subjects had greater illness severity by Acute Physiology and Chronic Health Evaluation II scores (29 [24-31] vs 24 [22-25]; P < .01). Hospital mortality was not higher among HIV-1-infected subjects compared with HIV-1-uninfected subjects (50.0% vs 38.4%; P = .19). CONCLUSIONS: In patients with ARDS, HIV-1 infection was associated with greater illness severity but was not associated with higher mortality in ARDS. Future studies need to be done to evaluate the factors that contribute to high morbidity and mortality in medically vulnerable populations who develop ARDS.
PURPOSE: We determined the prevalence of risk factors for the development of acute respiratory distress syndrome (ARDS), outcomes of critical illness, and the impact of highly active antiretroviral therapy in HIV-1-infectedpatients. We hypothesized that in an urban county hospital, HIV-1-infectedpatients with ARDS would have a higher mortality than their HIV-1-uninfected counterparts. MATERIALS AND METHODS: Subjects were enrolled between 2006 and 2012. Baseline patient demographics, comorbidities, illness severity, causes of ARDS, and clinical outcomes were obtained. The primary end point was hospital mortality. RESULTS: A total of 178 subjects with ARDS were enrolled in the study; 40 (22%) were infected with HIV-1. The median CD4 count was 75 (15.3-198.3), and 25% were on highly active antiretroviral therapy. HIV-1-infected subjects were significantly younger (44 vs 52 years; P < .01) and had higher rates of asthma, chronic obstructive pulmonary disease, pneumonia, history of hospital-acquired infections, and prior sepsis. HIV-1-infected subjects had greater illness severity by Acute Physiology and Chronic Health Evaluation II scores (29 [24-31] vs 24 [22-25]; P < .01). Hospital mortality was not higher among HIV-1-infected subjects compared with HIV-1-uninfected subjects (50.0% vs 38.4%; P = .19). CONCLUSIONS: In patients with ARDS, HIV-1 infection was associated with greater illness severity but was not associated with higher mortality in ARDS. Future studies need to be done to evaluate the factors that contribute to high morbidity and mortality in medically vulnerable populations who develop ARDS.
Authors: Pedro A Mendez-Tellez; Abdulla Damluji; Douglas Ammerman; Elizabeth Colantuoni; Eddy Fan; Jonathan E Sevransky; Carl Shanholtz; Joel E Gallant; Peter J Pronovost; Dale M Needham Journal: Crit Care Med Date: 2010-07 Impact factor: 7.598
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R Legall; A Morris; R Spragg Journal: Am J Respir Crit Care Med Date: 1994-03 Impact factor: 21.405
Authors: Agnes Meybeck; Lydie Lecomte; Michel Valette; Nicolas Van Grunderbeeck; Nicolas Boussekey; Arnaud Chiche; Hugues Georges; Yazdan Yazdanpanah; Olivier Leroy Journal: AIDS Res Ther Date: 2012-09-28 Impact factor: 2.250
Authors: Matthew C Woodruff; Richard P Ramonell; Natalie S Haddad; Fabliha A Anam; Mark E Rudolph; Tiffany A Walker; Alexander D Truong; Adviteeya N Dixit; Jenny E Han; Monica Cabrera-Mora; Martin C Runnstrom; Regina Bugrovsky; Jennifer Hom; Erin C Connolly; Igor Albizua; Vidhi Javia; Kevin S Cashman; Doan C Nguyen; Shuya Kyu; Ankur Singh Saini; Michael Piazza; Christopher M Tipton; Arezou Khosroshahi; Greg Gibson; Greg S Martin; Cheryl L Maier; Annette Esper; Scott A Jenks; F Eun-Hyung Lee; Ignacio Sanz Journal: Nature Date: 2022-08-31 Impact factor: 69.504