Short- and long-term outcomes of HIV-infected patients admitted to the intensive care unit impact of antiretroviral therapy and immunovirological status 英文参考文献.docVIP

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Short- and long-term outcomes of HIV-infected patients admitted to the intensive care unit impact of antiretroviral therapy and immunovirological status 英文参考文献.doc

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Short- and long-term outcomes of HIV-infected patients admitted to the intensive care unit impact of antiretroviral therapy and immunovirological status 英文参考文献

Morquinetal.AnnalsofIntensiveCare2012,2:25 /content/2/1/25 RESEARCH OpenAccess Short-andlong-termoutcomesofHIV-infected patientsadmittedtotheintensivecareunit: impactofantiretroviraltherapyand immunovirologicalstatus DavidMorquin1,2,6*,VincentLeMoing2,ThibautMura3,4,AlainMakinson2,KadaKlouche5,OlivierJonquet1,5, JacquesReynes2andPhilippeCorne1 Abstract Background:Thepurposeofthisstudywastoassesstheshort-andlong-termoutcomesofHIV-infectedpatients admittedtointensivecareunits(ICU)accordingtoimmunovirologicalstatusatadmissionandhighlyactive antiretroviraltherapy(HAART)useinICU. Methods:Retrospectivestudyof98HIV-infectedpatientshospitalizedbetween1997and2008intwomedicalICU inMontpellier,France.TheprimaryoutcomewasmortalityinICU.Thesecondaryendpointwasprobabilityof survivalintheyearfollowingICUadmission. Results:Eighty-two(83.6%)admissionsinICUwererelatedtoHIVinfectionand45%ofpatientshadreceived HAARTbeforeadmission.Sixty-twopatients(63.3%)weredischargedfromICU,and34(34.7%)werealiveat1year. PlasmaHIVRNAviralload(VL)andCD4+cellcountseparatelywerenotassociatedwithoutcome.Independent predictorsofICUmortalityweretheuseofvasopressiveagents(oddsratio(OR),3.779;95%confidenceinterval(CI), 1.11–12.861;p=0.0334)andSAPSIIscore(OR,1.04;95%CI,1.003-1.077;p=0.0319),whereasintroducingor continuingHAARTinICUwasprotective(OR,0.278;95%CI,0.082-0.939;p=0.0393).Factorsindependently associatedwith1-yearmortalitywereimmunovirologicalstatuswithhighVL(3log10/ml)andlowCD4(200/ 3 mm ;hazardratio(HR),5.19;95%CI,1.328-20.279;p=0.0179)orlowVL(3log10/ml)andlowCD4(HR,4.714;95% CI,1.178-18.867;p=0.0284)vs.highCD4andlowVL,coinfectionwithChepatitisvirus(HR,3.268;95%CI,1.29-8.278; p=0.0125),theuseofvasopressiveagents(HR,3.68;95%CI,1.394-9.716;p=0.0085),andSAPSIIscore(HR,1.09; 95%CI,1.057-1.124;p0.0001).IntroducingHAARTinapatientwithnoHAARTatadmissionwasassociatedwitha betterlong-termoutcome(HR,0.166;95%CI,0.043-0.642;p =0.0093). Conclusions:InapopulationofHIV-infectedpatientsadmittedtoICU,short-andlong-