Michaëla A Huson1, Ferishta Bakhshi-Raiez, Martin P Grobusch, Evert de Jonge, Nicolette F de Keizer, Tom van der Poll. 1. 1Center for Experimental and Molecular Medicine, Academic Medical Center, Amsterdam, The Netherlands. 2Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3Stichting Nationale Intensive Care Evaluatie, Amsterdam Medical Center, Amsterdam, The Netherlands. 4Division of Internal Medicine, Department of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands. 5Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
OBJECTIVE: Knowledge on characteristics and outcome of ICU patients with AIDS is highly limited. We aimed to determine the main reasons for admission and outcome in ICU patients with AIDS and trends over time therein. DESIGN: A retrospective study within the Dutch National Intensive Care Evaluation registry. SETTING: Dutch ICUs. PATIENTS: We used data collected between 1997 and 2014. Characteristics of patients with AIDS were compared with ICU patients without AIDS, matched for age, sex, admission type, and admission year. Joinpoint regression analysis was applied to study trends over time. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1,127 patients with AIDS and 4,479 matched controls. The main admission diagnoses of patients with AIDS were respiratory infection (28.6%) and sepsis (16.9%), which were less common in controls (7.7% and 7.5%, respectively; both p < 0.0001). Patients with AIDS had increased severity of illness and in-hospital mortality (28.2% vs 17.8%; p < 0.0001) compared with controls, which was associated with a higher rate of infections at admission in patients with AIDS (58.4% vs 25.5%). Over time, the proportion of patients with AIDS admitted with an infection decreased (75% in 1999 to 56% in 2013). Mortality declined in patients with AIDS (39% in 1999 to 16% in 2013), both in patients with or without an infection. Mortality also declined in matched controls without AIDS, but to a lesser extent. CONCLUSION: Infections are still the main reason for ICU admission in patients with AIDS, but their prevalence is declining. Outcome of patients with AIDS continued to improve during a time of widespread availability of combination antiretroviral therapy, and mortality is reaching levels similar to ICU patients without AIDS.
OBJECTIVE: Knowledge on characteristics and outcome of ICU patients with AIDS is highly limited. We aimed to determine the main reasons for admission and outcome in ICU patients with AIDS and trends over time therein. DESIGN: A retrospective study within the Dutch National Intensive Care Evaluation registry. SETTING: Dutch ICUs. PATIENTS: We used data collected between 1997 and 2014. Characteristics of patients with AIDS were compared with ICU patients without AIDS, matched for age, sex, admission type, and admission year. Joinpoint regression analysis was applied to study trends over time. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 1,127 patients with AIDS and 4,479 matched controls. The main admission diagnoses of patients with AIDS were respiratory infection (28.6%) and sepsis (16.9%), which were less common in controls (7.7% and 7.5%, respectively; both p < 0.0001). Patients with AIDS had increased severity of illness and in-hospital mortality (28.2% vs 17.8%; p < 0.0001) compared with controls, which was associated with a higher rate of infections at admission in patients with AIDS (58.4% vs 25.5%). Over time, the proportion of patients with AIDS admitted with an infection decreased (75% in 1999 to 56% in 2013). Mortality declined in patients with AIDS (39% in 1999 to 16% in 2013), both in patients with or without an infection. Mortality also declined in matched controls without AIDS, but to a lesser extent. CONCLUSION: Infections are still the main reason for ICU admission in patients with AIDS, but their prevalence is declining. Outcome of patients with AIDS continued to improve during a time of widespread availability of combination antiretroviral therapy, and mortality is reaching levels similar to ICU patients without AIDS.
Authors: Maryse A Wiewel; Michaëla A Huson; Lonneke A van Vught; Arie J Hoogendijk; Peter M C Klein Klouwenberg; Janneke Horn; René Lutter; Olaf L Cremer; Marcus J Schultz; Marc J Bonten; Tom van der Poll Journal: Crit Care Date: 2016-10-10 Impact factor: 9.097