Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era 英文参考文献.docVIP

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Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era 英文参考文献.doc

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Coquet et al. Critical Care 2010, 14:R107 /content/14/3/R107 RESEARCH Open Access Survival trends in critically ill HIV-infected patients Research in the highly active antiretroviral therapy era Isaline Coquet1, Juliette Pavie2, Pierre Palmer3, Fran?ois Barbier1, Stéphane Legriel1, Julien Mayaux1, Jean Michel Molina2, Beno?t Schlemmer1 and Elie Azoulay*1 Abstract Introduction: The widespread use of highly active antiretroviral therapy (ART) has reduced HIV-related life-threatening infectious complications. Our objective was to assess whether highly active ART was associated with improved survival in critically ill HIV-infected patients. Methods: A retrospective study from 1996 to 2005 was performed in a medical intensive care unit (ICU) in a university hospital specialized in the management of immunocompromised patients. A total of 284 critically ill HIV-infected patients were included. Differences were sought across four time periods. Risk factors for death were identified by multivariable logistic regression. Results: Among the 233 (82%) patients with known HIV infection before ICU admission, 64% were on highly active ART. Annual admissions increased over time, with no differences in reasons for admission: proportions of patients with newly diagnosed HIV, previous opportunistic infection, CD4 counts, viral load, or acute disease severity. ICU and 90-day mortality rates decreased steadily: 25% and 37.5% in 1996 to 1997, 17.1% and 17.1% in 1998 to 2000, 13.2% and 13.2% in 2001 to 2003, and 8.6% in 2004 to 2005. Five factors were independently associated with increased ICU mortality: delayed ICU admission (odds ratio (OR), 3.04; 95% confidence interval (CI), 1.29 to 7.17), acute renal failure (OR, 4.21; 95% CI, 1.63 to 10.92), hepatic cirrhosis (OR, 3.78; 95% CI, 1.21 to 11.84), ICU admission for coma (OR, 2.73; 95% CI, 1.16 to 6.46), and severe sepsis (OR, 3.67; 95% CI, 1.53 to 8.80). Admission to the ICU in the most recent period was independently a