Impact of HIV/AIDS on care and outcomes of severe sepsis
Impact of HIV/AIDS on care and outcomes of severe sepsis
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DOI：
10.1186/cc3811
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发表时间：
2005-12-01
期刊：
影响因子：
15.1
通讯作者：
Johnston, JA
中科院分区：
文献类型：
--
作者：
Mrus, JM;Braun, L;Johnston, JA
艾滋病毒/艾滋病患者的生存率有了显着改善;然而，一些对艾滋病毒/艾滋病患者和严重疾病的研究报告了重症监护的持续率低。本研究的目的是检查严重脓毒症和艾滋病毒/艾滋病患者的护理模式和结果，并与严重脓毒症患者没有HIV/AIDS.Methods我们评估了所有1999年出院摘要在美国6个州的数据。提取患者的人口统计学特征、出院诊断、资源使用和结局。使用卡方，Wilcoxon秩和或回归技术进行分析，如appropriate.Results我们确定了74,020例严重脓毒症患者（7,638例（10.3%）有HIV/AIDS）使用ICD-9-CM代码。严重脓毒症和HIV/AIDS患者的平均住院时间相似（16.9天vs 17.7天; p = 0.0669），平均住院费用较低（24，382美元对30，537美元; p < 0.0001），不太可能被送入重症监护室（37%对56%; p < 0.0001），死亡率（29%对20%; p < 0.0001）高于未感染艾滋病毒/艾滋病的患者。校正队列差异后，严重脓毒症和HIV/AIDS患者的死亡可能性增加（OR（95% CI）= 2.41（2.23 - 2.61）），入住重症监护室的可能性显著降低（OR（95% CI）= 0.54（0.51 - 0.59））。与严重脓毒症和艾滋病毒/艾滋病患者相比，无艾滋病毒/艾滋病的严重脓毒症患者普遍更有可能被送入重症监护室，即使他们患有与预期住院死亡率相同或更差的共病（e.例如，在一个实施例中，结论对于严重脓毒症患者，HIV感染者/AIDS患者的护理和预后存在差异。需要进一步研究，以检查严重脓毒症和艾滋病毒/艾滋病患者的护理服务。
Introduction There has been dramatic improvement in survival for patients with HIV/AIDS; however, some studies on patients with HIV/AIDS and serious illness have reported continued low rates of intensive care. The purpose of this study was to examine patterns of care and outcomes for patients with severe sepsis and HIV/AIDS and compare them with those of patients with severe sepsis without HIV/AIDS.Methods We assessed data from all 1999 discharge abstracts from all non-federal hospitals in six US states. Patient demographic characteristics, discharge diagnoses, resource use, and outcomes were extracted. Analyses were performed using chi-square, Wilcoxon rank sum, or regression techniques, as appropriate.Results We identified 74,020 patients with severe sepsis ( 7,638 (10.3%) had HIV/AIDS) using ICD-9-CM codes. Patients with severe sepsis and HIV/AIDS had a similar mean length of stay (16.9 days versus 17.7 days; p = 0.0669), had lower mean hospitalization cost ($24,382 versus $ 30,537; p < 0.0001), were less likely to be admitted to the intensive care unit (37% versus 56%; p < 0.0001), and had a greater mortality (29% versus 20%; p < 0.0001) than those without HIV/AIDS. After adjustment for cohort differences, patients with severe sepsis and HIV/AIDS had increased likelihood of death ( OR (95% CI) = 2.41 (2.23 - 2.61)) and were substantially less likely to be admitted to the intensive care unit ( OR ( 95% CI) = 0.54 (0.51 - 0.59)). When compared with those with severe sepsis and HIV/AIDS, patients with severe sepsis without HIV/AIDS were universally more likely to be admitted to the intensive care unit, even when they had comorbid illnesses with equal or worse expected in-hospital mortality ( e. g., metastatic cancer).Conclusion For patients with severe sepsis, there are differences in care and outcomes for those with HIV/AIDS. Further research is needed to examine the delivery of care for patients with severe sepsis and HIV/AIDS.