Trends and characteristics of all-cause mortality among HIV-infected inpatients during the HAART era (2006-2015) in Shanghai, China
Trends and characteristics of all-cause mortality among HIV-infected inpatients during the HAART era (2006-2015) in Shanghai, China
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DOI：
10.5582/bst.2016.01195
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发表时间：
2017-01-01
影响因子：
5.5
通讯作者：
Lu, Hongzhou
中科院分区：
文献类型：
--
作者：
Ji, Yongjia;Wang, Zhenyan;Lu, Hongzhou
在全球范围内，艾滋病毒感染者的总死亡率在HAART时代显著下降。为了制定干预策略，进一步改善对这一人群的医疗护理及其预后，需要对感染艾滋病毒的住院患者的死亡进行特征分析。在本研究中，回顾性分析了2006年至2015年在中国上海一家HIV感染和艾滋病患者护理医疗中心住院的HIV感染患者的死亡情况。对死亡率趋势和艾滋病或与艾滋病无关的疾病造成的死亡比例进行了评价。进行双变量分析，以确定与艾滋病毒感染住院患者中艾滋病或非艾滋病相关死亡相关的人口统计学和临床因素。在2006年至2015年出院的6473名艾滋病毒感染者中，鉴定出326例死亡（5.04%）。随着时间的推移，年死亡率显著下降（x(2) = 34.41, p < 0.001）。结果显示，大多数死亡归因于艾滋病相关疾病（76.9%,233/303），死亡原因的比例随时间变化不显著（x(2) = 13.847, p = 0.127）。双变量分析确定了与艾滋病相关死亡率相关的特征因素。与非艾滋病相关疾病死亡的患者相比，艾滋病相关疾病死亡的患者入院时CD4+ T细胞计数低于50个细胞/ μ L (OR 4.587, 2.377-8.850)，肝脏（OR 0.391, 0.177-0.866）或肾脏合并症（OR 0.188,0.067-0.523）较少。结果表明，在过去十年中，艾滋病毒感染患者的总体住院死亡率有所下降。然而，艾滋病相关疾病仍然是艾滋病住院患者死亡的主要原因，这表明中国需要进一步努力改善艾滋病护理。
Globally, the overall mortality rate among HIV-infected patients has significantly declined during the HAART era. Deaths among HIV-infected inpatients need to be characterized in order to formulate intervention strategies to further improve medical care for this population and their prognosis. In the current study, deaths among HIV-infected inpatients from 2006 to 2015 at a medical center for HIV infection and AIDS patient care in Shanghai, China were retrospectively analyzed. Trends in mortality rates and the proportion of deaths caused by AIDS or non-AIDS-related illnesses were evaluated. A bivariate analysis was performed to identify the demographic and clinical factors associated with AIDS or non-AIDS-related deaths among HIV-infected inpatients. Among 6,473 HIV-infected patients who were discharged from 2006 to 2015, 326 deaths (5.04%) were identified. The yearly mortality rate declined significantly over time (x(2) = 34.41, p < 0.001). Results revealed that most deaths were attributed to AIDS-related illnesses (76.9 %, 233/303), and the proportion of causes of death did not change significantly over time (x(2) = 13.847, p = 0.127). Bivariate analysis identified characteristic factors associated with AIDS-related mortality. Compared to patients who died of non-AIDS illnesses, patients who died of AIDS-related illnesses had a CD4+ T cell count lower than 50 cells/mu L (OR 4.587, 2.377-8.850) and fewer liver (OR 0.391, 0.177-0.866) or renal comorbidities (OR 0.188 ,0.067-0.523) on admission. Results indicated that the overall in-hospital mortality rate among HIV-infected patients has declined over the past decade. However, AIDS-related illnesses were still the major causes of deaths among HIV-infected inpatients, suggesting that further efforts are needed to improve AIDS care in China.