The role of HIV infection and drug and alcohol dependence in hospital mortality among critically ill patients
The role of HIV infection and drug and alcohol dependence in hospital mortality among critically ill patients
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DOI：
10.1016/j.jcrc.2007.04.001
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发表时间：
2008-09-01
影响因子：
3.7
通讯作者：
Dodek, P. M.
中科院分区：
文献类型：
--
作者：
Palepu, A.;Khan, N. A.;Dodek, P. M.
目的：由于艾滋病毒治疗的进展和重症监护病房（ICU）管理的普遍改善，艾滋病毒感染患者的重症监护结果有所改善。艾滋病毒感染患者中药物和酒精依赖的发生率很高，感染和未感染艾滋病毒的患者中药物和酒精依赖在危重疾病结局中的独立作用尚不清楚。材料与方法：对1999年1月至2006年1月2所教学医院7015例ICU住院患者的前瞻性数据进行分析。ICU的诊断是通过前瞻性图表回顾确定的，并根据重症监护国家审计和研究委员会制定的诊断词典进行分类。我们使用逻辑回归来确定药物和酒精依赖以及HIV感染与院内死亡率的独立关联，调整的协变量包括急性药物过量、急性生理和慢性健康评估II评分、年龄、性别、医院地点和社会经济变量。结果：在所有患者中，4.4%（7015例中有309例）感染HIV；其中，56%（309人中的173人）有药物和酒精依赖史，而艾滋病毒阴性组中只有7.4%（6706人中的502人）有药物和酒精依赖史。无论是纳入所有住院患者的模型（调整优势比[AOR] 0.80； 95%可信区间[CI] 0.62-1.03），还是仅纳入肺炎和败血症住院患者的模型（调整优势比[AOR] 0.92； 95%可信区间[CI] 0.59-1.41），药物和酒精依赖均未与住院死亡率独立相关。HIV感染与住院死亡率独立相关（AOR 2.16; 95% CI 1.60-2.93）。结论：虽然HIV感染与住院死亡率增加有关，但药物和酒精依赖与HIV感染无关的住院死亡率增加无关。(c) 2008爱思唯尔公司版权所有。
Purpose: Critical care outcomes among HIV-infected patients have improved because of advances in HIV therapy and general improvements in intensive care unit (ICU) management. There is a high co-occurrence of drug and alcohol dependence among HIV-infected patients, and the independent role of drug and alcohol dependence among patients with and without HIV infection in outcomes of critical illness is unclear.Materials and methods: We analyzed a prospectively collected database of 7015 index ICU admissions at 2 teaching hospitals between January 1999 and January 2006. The ICU diagnoses were determined from prospective chart review and classified according to the dictionary of diagnoses developed by the Intensive Care National Audit and Research Council. We used logistic regression to determine the independent association of drug and alcohol dependence as well as HIV infection with in-hospital mortality, Covariates that were adjusted for included acute drug overdose, Acute Physiology and Chronic Health Evaluation II score, age, sex, hospital site, and socioeconomic variables.Resutts: Of all patients, 4.4% (309 of 7015) were HIV infected; and of these, 56%, (173 of 309) had a history of drug and alcohol dependence, whereas only 7.4%(, (502 of 6706) of the HIV-negative group had a history of drug and alcohol dependence. Drug and alcohol dependence was not independently associated with hospital mortality in either the model including all admissions (adjusted odds ratio [AOR] 0.80; 95% confidence interval [CI] 0.62-1.03) or the model including pneumonia and sepsis admissions only (AOR 0.92; 95% CI 0.59-1.41). Infection with HIV was independently associated with hospital mortality (AOR 2.16; 95% CI 1.60-2.93).Conclusions: Although HIV infection is associated with increased hospital mortality, drug and alcohol dependence is not associated with,in increased hospital mortality independent of HIV infection. (c) 2008 Elsevier Inc. All rights reserved.