Sepsis is a major determinant of outcome in critically ill HIVAIDS patients 英文参考文献.docVIP

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Sepsis is a major determinant of outcome in critically ill HIVAIDS patients 英文参考文献.doc

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Sepsis is a major determinant of outcome in critically ill HIVAIDS patients 英文参考文献

Japiassúetal.CriticalCare2010,14:R152 /content/14/4/R152 RESEARCH OpenAccess Sepsisisamajordeterminantofoutcomein criticallyillHIV/AIDSpatients AndréMJapiassú1,RodrigoTAmancio1,EmersonCMesquita1,DeniseMMedeiros1,HelenaBBernal2, Estev?oPNunes2,PaulaMLuz2,BeatrizGrinsztejn2,FernandoABozza1* Abstract Introduction:NewchallengeshavearisenforthemanagementofcriticallyillHIV/AIDSpatients.Severesepsishas emergedasacommoncauseofintensivecareunit(ICU)admissionforthoselivingwithHIV/AIDS.Contrastingly, HIV/AIDSpatientshavebeensystematicallyexcludedfromsepsisstudies,limitingtheunderstandingoftheimpact ofsepsisinthispopulation.WeprospectivelyfollowedupcriticallyillHIV/AIDSpatientstoevaluatethemainrisk factorsforhospitalmortalityandtheimpactofseveresepsisontheshort-andlong-termsurvival. Methods:AllconsecutiveHIV-infectedpatientsadmittedtotheICUofaninfectiousdiseasesresearchcenter,from June2006toMay2008,wereincluded.Severityofillness,timesinceAIDSdiagnosis,CD4cellcount,antiretroviral treatment,incidenceofseveresepsis,andorgandysfunctionswereregistered.The28-day,hospital,and6-month outcomeswereobtainedforallpatients.Coxproportionalhazardsregressionanalysismeasuredtheeffectof potentialfactorson28-dayand6-monthmortality. Results:Duringthe2-yearstudyperiod,88HIV/AIDScriticallyillpatientswereadmittedtotheICU.Seventy percentofpatientshadopportunistinfections,medianCD4countwas75cells/mm3,and45%werereceiving antiretroviraltherapy.LocationonawardbeforeICUadmission,cardiovascularandrespiratorydysfunctionsonthe firstdayafteradmission,andthepresenceofseveresepsis/septicshockwereassociatedwithreduced28-dayand 6-monthsurvivalonaunivariateanalysis.Afteramultivariateanalysis,severesepsisdeterminedthehighesthazard ratio(HR)for28-day(adjustedHR,3.13;95%CI,1.21-8.07)and6-month(adjustedHR,3.35;95%CI,1.42-7.86) mortality.Severesepsisoccurredin44(50%)patients,mainlybecauseoflowerrespiratorytractinfections.The survivalofsepticandnonsepticpatientswassignificantlydifferentat28-dayand6-monthfollow-uptimes(