Etiologies and outcome of acute respiratory failure in HIV-infected patients
Etiologies and outcome of acute respiratory failure in HIV-infected patients
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DOI：
10.1007/s00134-009-1559-4
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发表时间：
2009-10-01
影响因子：
38.9
通讯作者：
Azoulay, Elie
中科院分区：
文献类型：
--
作者：
Barbier, Francois;Coquet, Isaline;Azoulay, Elie
旨在评估使用联合抗逆转录病毒疗法 (ART) 的头十年内 HIV 感染者急性呼吸衰竭 (ARF) 的病因和结果。对 1996 年至 2006 年间因 ARF 入住单一重症监护病房 (ICU) 的所有 HIV 感染者 (n = 147) 进行回顾性研究。ARF 揭示了 43 名 (29.2%) 患者的 HIV 感染诊断。 ARF 的病因包括细菌性肺炎 (n = 74)、耶氏肺孢子菌肺炎 (PCP，n = 52)、其他机会性感染 (n = 19) 和非感染性肺部疾病 (n = 33)；在 10 年的研究期间，原因的分布没有变化。在 33 名患者中发现了两个或多个原因。接受 ART 的 43 名患者患细菌性肺炎的频率较高，而机会性感染的频率较低（P = 0.02）。 49 名患者需要无创通气，42 名患者需要气管插管。医院死亡率为 19.7%。与死亡率独立相关的因素包括机械通气[比值比 (OR) = 8.48，P < 0.0001]、血管加压药的使用（OR，4.48；P = 0.03）、从入院到入住 ICU 的时间（OR，每天 1.05；P = 0.01）和原因数量（OR，3.19；P = 0.02）。 HIV 相关变量（CD4 计数、病毒载量和 ART）与死亡率无关。细菌性肺炎和 PCP 仍然是 ART 时代 HIV 感染患者 ARF 的主要原因。医院生存率有所提高，并且取决于器官功能障碍的程度，而不是艾滋病毒相关特征。
To assess the etiologies and outcome of acute respiratory failure (ARF) in HIV-infected patients over the first decade of combination antiretroviral therapy (ART) use.Retrospective study of all HIV-infected patients (n = 147) admitted to a single intensive care unit (ICU) for ARF between 1996 and 2006.ARF revealed the diagnosis of HIV infection in 43 (29.2%) patients. Causes of ARF were bacterial pneumonia (n = 74), Pneumocystis jirovecii pneumonia (PCP, n = 52), other opportunistic infections (n = 19), and noninfectious pulmonary disease (n = 33); the distribution of causes did not change over the 10-year study period. Two or more causes were identified in 33 patients. The 43 patients on ART more frequently had bacterial pneumonia and less frequently had opportunistic infections (P = 0.02). Noninvasive ventilation was needed in 49 patients and endotracheal intubation in 42. Hospital mortality was 19.7%. Factors independently associated with mortality were mechanical ventilation [odds ratio (OR) = 8.48, P < 0.0001], vasopressor use (OR, 4.48; P = 0.03), time from hospital admission to ICU admission (OR, 1.05 per day; P = 0.01), and number of causes (OR, 3.19; P = 0.02). HIV-related variables (CD4 count, viral load, and ART) were not associated with mortality.Bacterial pneumonia and PCP remain the leading causes of ARF in HIV-infected patients in the ART era. Hospital survival has improved, and depends on the extent of organ dysfunction rather than on HIV-related characteristics.